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Tuesday, 11 January, 2000, 03:45 GMT
Many patients 'move after death'

Lazarus Lazarus: Risen from the dead

Almost four in ten patients move spontaneously after they have been diagnosed as brain dead, researchers have found.

Movements include jerking of fingers and bending of the toes.

Such movements can be disturbing to family members, and may even cause health professionals to question the accuracy of their diagnosis.

If the lack of understanding of these movements leads to a delay in the brain death diagnosis or questions about the diagnosis afterwards, there can be important practical and legal implications
Dr Jose Bueri, neurologist
Writing in Neurology, the scientific journal of the American Academy of Neurology, researcher Dr Jose Bueri said: "We found that these movements are more common than has been reported or believed.

"People need to know that these movements are spinal reflexes that do not involve any brain activity."

The study examined all patients with a diagnosis of brain death at the JM Ramos Mejia Hospital in Buenos Aires, Argentina, during an 18-month period.

Of the 38 patients, 15 had these motor movements.

In all cases, the movements were seen in the first 24 hours after brain death diagnosis, and no movements were seen after 72 hours.

Some of the movements occurred spontaneously; others were triggered by touch.

Examiners used tests designed to elicit motor movements, such as lifting the arms or legs or touching the palm of the hand.

Electroencephalogram (EEG) tests did not show any brain activity in any of the patients with movements.

Dr Bueri said: "If the lack of understanding of these movements leads to a delay in the brain death diagnosis or questions about the diagnosis afterwards, there can be important practical and legal implications, especially for organ procurement for transplantation.

"Family members and others need to understand that these movements originate in the spinal cord, not in the brain, and their presence does not mean that there is brain activity."

Lazarus sign

Lazarus sign
The arms are stretched
They are crossed or touched on the chest
They fall alongside the torso
One of the most startling movements for family members and health care professionals is called the "Lazarus sign".

It is a sequence of movements lasting for a few seconds that can occur in some brain dead patients, either spontaneously or right after the ventilator is disconnected.

It is named for the episode in the Bible where Lazarus is raised from the dead.

Dr Bueri said: "It starts with stretching of the arms, followed by crossing or touching of the arms on the chest, and finally falling of the arms alongside the torso.

"It is also a spinal reflex, but it can be disturbing to family members and others who see this."

Unusual movements

Another article in this issue of Neurology describes unusual movements in two brain dead patients.

The movements occurred in a 30-year-old woman and an 11-month-old baby at a hospital in Barcelona, Spain.

Both patients extended their arms, flexed their wrists and curled up their fingers each time the mechanical ventilator inflated their lungs.

The movements stopped after the patients were disconnected from the ventilator.

Neurologist Dr Joan Marti-Fabregas, of the Hospital de la Santa Creu i Sant Pau, said: "We had never seen these type of movements before, and they hadn't been reported in the medical journals."

The doctors conducted additional tests and confirmed that there was no brain activity.

"The living cells that were ordering these muscles to move were not brain cells or brain stem cells, but cells located in the spinal cord," he said.

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