A coma is a state of prolonged unconsciousness that can be caused by a variety of conditions, including traumatic brain injury, stroke, brain tumor, drug or alcohol intoxication, or even an underlying illness like diabetes or an infection. Patients in a coma show very little outward response to stimulation, and cannot be awakened. They may breathe on their own, or require mechanical ventilation to breathe for them. Comas can last for days, weeks, or even years in some extreme cases. But who has been in the longest coma ever recorded in medical history?
What is a coma?
A coma is a profound state of unconsciousness in which a person cannot be awakened. It is usually the result of significant brain trauma or damage. While in a coma, a person shows no outward signs of awareness or consciousness. They do not open their eyes, speak, or show signs of understanding their surroundings. They may only exhibit primitive reflexes.
Comas are distinct from states like brain death, vegetative states, or sleep. A person in a coma still has functioning brain stem reflexes and may breathe on their own, while someone who is brain dead has no brain function at all. Vegetative states show some signs of limited awareness that coma patients do not. And of course, comas are not normal sleep since a comatose person cannot be woken up.
The level of unconsciousness in a coma is so deep that even powerful stimulation like pain inflicted by pinching or calling the person’s name does not elicit any reactions. Doctors use scoring systems like the Glasgow Coma Scale to rate the depth of a coma on a scale from 3 to 15 based on verbal, motor, and eye reflex responses. A score of 3 indicates the deepest level of coma, while 15 is normal wakefulness.
Causes of Coma
There are many potential causes of a coma, including:
– Traumatic brain injury from accidents, assaults, falls, sports injuries or other head trauma
– Lack of oxygen to the brain, which can occur during cardiac arrest, respiratory arrest, stroke or other interruptions of blood flow
– Toxic substances like drugs, alcohol, poisons, medications or chemicals
– Infections like encephalitis, meningitis or sepsis
– Stroke or aneurysms that cause bleeding in the brain
– Brain tumors compressing parts of the brain
– Severe hypoglycemia due to diabetes or starvation
– Severe dehydration or electrolyte imbalances
– High or low body temperature (hyperthermia or hypothermia)
– Liver or kidney diseases leading to metabolic disorders
In some cases, the specific cause of the coma cannot be identified. The depth and duration of the coma depends on the area and extent of the brain affected. Mild or short comas may be harder to precisely diagnose.
Longest Comas on Record
Modern medicine has enabled coma patients to be sustained on life support for extended periods of time. With care, some coma patients emerge after weeks or months with limited recovery. In rare cases, comas have persisted for decades. These are some of the longest recorded comas in medical history:
Elaine Esposito – 37 years
The longest coma on record was that of Elaine Esposito of Florida, USA, who remained comatose for 37 years and 111 days before passing away in November 1978 at the age of 43. When she was 6, Esposito was anesthetized for an appendectomy in August 1941 but she never awoke afterward. Her surgery appeared to have been successful and the cause of her prolonged unconsciousness was never determined. Esposito spent over three decades at Miami’s Jackson Memorial Hospital in a coma, likely in a vegetative state rather than a true coma based on some subtle responses over the years. She ultimately succumbed to pneumonia and kidney failure in 1978. Her case appeared in the Guinness Book of Records for the longest coma ever.
Edwarda O’Bara – 42 years
Another remarkably long coma was that of Edwarda O’Bara of Florida. In 1970 at age 16, O’Bara suddenly fell asleep and did not wake up again for over 42 years until her death in 2012 at age 59. After collapsing at school, she was initially only expected to remain in a coma for a few weeks but never regained consciousness. Her family cared for her at home with a feeding tube for decades, until she passed away from natural causes. While a 42 year coma is widely reported based on family accounts, medical evidence to confirm the diagnosis over that time is lacking.
Ariel Sharon – 8 years
Former Israeli Prime Minister Ariel Sharon spent his last eight years of life in a vegetative state after suffering a major stroke and brain hemorrhage in January 2006 at age 78. He underwent multiple surgeries and remained in a coma for months. In subsequent years up until his death in 2014, reports differ on whether Sharon regained some degree of consciousness or responsiveness along with spontaneous eye opening and movement. While his coma may have transitioned into a vegetative state or minimal consciousness, it ranks among one of the longest medically recorded comas after such a stroke.
Terry Wallis – 19 years
In 1984, 19-year-old Terry Wallis of Arkansas fell into a deep coma after a car accident. For 19 years he remained unresponsive, cared for at home by his mother. In 2003, suddenly Wallis awoke and regained awareness, becoming one of the few extremely long-term coma patients to make a recovery. He gradually relearned how to talk and move, though with significant permanent impairments. Wallis passed away in 2019 at age 57. His case was important in suggesting the potential for neural recovery even years after a traumatic brain injury.
Kate Allatt – 3 months
Kate Allatt is one of the longest survivors of a coma in the United Kingdom. In 2010, she contracted a cold that progressed to pneumonia and sepsis. Following cardiac arrest, she fell into a coma for 12 weeks. Allatt made headlines in the UK for eventually making a recovery against high odds, though she suffered significant memory loss and has required years of intensive rehabilitation. Within the British healthcare system, few patients have survived a coma as long as Allatt’s. Her astonishing recovery has allowed her to share her story to provide hope to other coma patients and their families.
| Name | Length of Coma | Year |
|---|---|---|
| Elaine Esposito | 37 years 111 days | 1941 – 1978 |
| Edwarda O’Bara | 42 years | 1970 – 2012 |
| Ariel Sharon | 8 years | 2006 – 2014 |
| Terry Wallis | 19 years | 1984 – 2003 |
| Kate Allatt | 3 months | 2010 |
Factors Affecting Coma Duration and Recovery
Several key factors impact how long a coma may last and the potential for recovery:
Cause of the Coma
The underlying cause of the comatose state plays a major role. Comas from drug overdoses or metabolic issues often have better prognoses than those from traumatic brain injury, stroke, or oxygen deprivation. The degree of damage and how widespread it is in the brain impacts duration. Localized injury may have better outcomes than diffuse harm.
Time in Coma
In general, shorter comas tend to have higher recovery rates. The longer someone remains comatose, the less likely they may be to wake up and recover meaningful function. After 4 weeks in a coma, chances of moderate disability or better drop below 50%, and after 8 weeks, chances of severe disability rise above 90%. Vegetative states within 2 to 5 weeks have better odds of recovery than after a year.
Age
Younger patients generally have better prospects of waking from a coma than older adults. The developing brains of children and teens may be more resilient. But recovery may vary more based on injury specifics.
Severity of Injury
Milder neurological damage often correlates with shorter coma durations and better outcomes. The more extensive the damage, the less likely full recovery becomes. However, severity can be complex to gauge.
Location of Injury
The location of injury in the brain also matters. Damage to “higher” cortical areas governing consciousness, cognition and reasoning may preclude meaningful recovery more than damage limited to “lower” brain areas controlling basic functions like breathing. However small regions can have widespread effects.
Health Status
A patient’s overall health also plays a role. Better pre-coma health may improve odds versus multiple chronic illnesses. But even significant pre-existing conditions do not preclude recovery chances altogether.
Quality of Care
The quality of medical care during the coma can enable a better outcome. Measures like controlling fluids, electrolytes and nutrition, preventing infections, and physical therapy all help avoid further health complications. Home care by dedicated family members has enabled some extremely long comas.
Recovery Prospects
Comas remain some of the most complex and least understood conditions in medicine. There are currently no reliable methods to accurately predict time spans or recovery chances for individual patients. We only have statistics based on aggregate cases that provide rough probabilities and averages. Each coma and brain is unique.
But recovery is possible even from very long comas lasting months or years. The fact that patients like Terry Wallis have regained consciousness and some degree of function after 19 years provides a glimmer of hope even in the most hopeless-seeming cases. Some neurologists argue that we should distinguish “outcome” from “recovery” – even patients who do not make full recoveries may show meaningful progress and improvement from their coma state.
There are increasing efforts to develop neural stimulation techniques and communications tools to better facilitate recovery from comas and related disorders of consciousness. These include technologies like brain computer interfaces and treatment approaches using electrical nerve stimulation or sensory stimulation.
Advances in neuroimaging also continue to reveal more about comas and levels of awareness in apparently unresponsive patients. Even simple, low-cost interventions in care like music, sensory and social stimulation are being investigated for potential positive impacts on arousal and brain recovery. Hope should not be abandoned even decades into a coma. With care, time and tools, more awakenings may be possible.
Conclusion
Comas lasting weeks, months and even longer have occurred throughout medical history. Cases like Elaine Esposito and Edwarda O’Bara demonstrate that survival for decades in a coma, likely a vegetative state rather than true coma, is possible though extremely rare. Shorter term comas measured in days to weeks are more common, with recovery chances declining but not disappearing the longer a coma persists. While outcomes are variable and unpredictable, ongoing advances in neurology continue to unveil new possibilities for restoring consciousness and function in patients with even the most severe brain injuries, given time, technology and devoted care. Hope thus remains for reawakening the most unresponsive minds.