What percentage of coma patients wake up?

Comas aren’t just a form of deep sleep. In fact, sleep is a complex and specific pattern of brain activity that requires a healthy brain to perform it (and just happens to produce unconsciousness as a side effect). Your brain just temporarily switches off consciousness – and various stimuli can make your brain switch it back on. A sufficiently loud noise, a certain amount of physical touch or movement of the body in space, a shot of adrenaline as in your question, etc. will all send signals to that switch and flip it back to the “on” position.

A coma is a lack of activity. The consciousness switch (parts of the ascending reticular activating system) is broken, or the wires leading it to the machinery of consciousness (other parts of the ARAS) are not working, or the machinery itself (cerebral cortex) is hopelessly damaged. This damage can be due to lack of oxygen (suffocation, drowning, opioid overdose, stroke) or due to mechanical injury, but in all cases, the neurons are severely damaged or dead. In some cases a signal can’t even get to the ARAS. Even if it can, the ARAS and/or the cortex can’t respond like it should. That’s the entire reason the coma is happening, and it’s the reason that playing Justin Bieber at full blast or jostling the person won’t wake them up either.

a coma is what happens when your on/off switch is broken or disconnected. Trying to hit the on/off switch won’t solve the problem.

There are very rare cases of people waking up after over a month or two – more like the Hollywood stories. These are cases where a person had severe permanent injury, but the brain was able to recover very slowly by mechanisms we don’t yet understand. Some theories include the regeneration of dead neurons, generation of new neurons, or rewiring of existing living neurons to serve the functions of the dead ones. It’s extremely rare, and the patients in these cases don’t wake up to anywhere near their previous level of functioning – they have multiple very severe neurologic deficits, not to mention severe muscle wasting and loss of stamina due to their complete inactivity. Also typically happens within the first 6 months if it is going to happen. Outside of maybe a handful of people in the history of the world, stories of people waking up after over a year are purely fictional.

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