Near-Death Experiences in patients with locked-in syndrome: Not always a blissful journey

Effects of Knowledge of Near-Death Experiences (NDEs) on Life Changes in People without NDEs

Background and Objective: Near-death experiences (NDEs) greatly change the lives of Near-death experiencers (NDErs); however, the influence of the knowledge of these experiences on other people is unclear. Therefore, the present study aimed to investigate the effects of knowledge of NDEs on various aspects of life and the sleep quality of those without NDEs. Methods: The research population consisted of people aged 12-60 years living in a number of different cities in Iran during 2021. A total of 766 out of 800 individuals who met the inclusion criteria completed the self-report questionnaires. Also, 466 respondents (60.8%) were women. Results: The findings of the study indicated that 57.6%, 58.1%, 72.1%, 79.6%, and 70.9% of the respondents acquired knowledge about NDEs through reading books and articles, watching movies and clips, using social media and networks, listening to lectures, and chatting with friends, respectively. Data analysis showed that 40% of the respondents reported a drastic change in their views or feelings and 57% experienced positive effects in their lives after learning about NDEs. Overall, the data in this study confirmed that most individuals were profoundly affected after exposure to NDEs. Conclusion: Knowledge of NDEs improves the quality of life, mental health, sleep quality, and the understanding of the life and death of most individuals without NDEs. Although there are some changes that are not necessarily positive and in some cases changes have been associated with negative consequences, later in this paper, the relevant associations and cautions are discussed.

Characterization of near death experiences using text mining analyses: A preliminary study

The notion that death represents a passing to an afterlife, where we are reunited with loved ones and live eternally in a utopian paradise, is common in the reports of people who have encountered a “Near-Death Experience” (NDE). NDEs are thoroughly portrayed by the media but empirical studies are rather recent. The definition of the phenomenon as well as the identification of NDE experiencers is still a matter of debate. To date, NDEs’ identification and description in studies have mostly derived from answered items in questionnaires. However, questionnaires’ content could be restricting and subject to personal interpretation. We believe that in addition to their use, user-independent statistical text examination of freely expressed NDEs narratives is of prior importance to help capture the phenomenology of such a subjective and complex phenomenon. Towards that aim, we included 158 participants with a firsthand retrospective narrative of their self-reported NDE that we analyzed using an automated text-mining method. The output revealed the top words expressed by experiencers. In a second step, a hierarchical clustering analysis was conducted to visualize the relationships between these words. It revealed three main clusters of features: visual perceptions, emotions and spatial components. We believe the user-independent and data-driven text mining approach used in this study is promising by contributing to the building a rigorous description and definition of NDEs.

Migraine aura, a predictor of near-death experiences in a crowdsourced study

Background

Near-death experiences (NDE) occur with imminent death and in situations of stress and danger but are poorly understood. Evidence suggests that NDE are associated with rapid eye movement (REM) sleep intrusion, a feature of narcolepsy. Previous studies further found REM abnormalities and an increased frequency of dream-enacting behavior in migraine patients, as well as an association between migraine with aura and narcolepsy. We therefore investigated if NDE are more common in people with migraine aura.

Methods

We recruited 1,037 laypeople from 35 countries and five continents, without any filters except for English language and age ≥18 years, via a crowdsourcing platform. Reports were validated using the Greyson NDE Scale.

Results

Eighty-one of 1,037 participants had NDE (7.8%; CI [6.3-9.7%]). There were no significant associations between NDE and age (p > 0.6, t-test independent samples) or gender (p > 0.9, Chi-square test). The only significant association was between NDE and migraine aura: 48 (6.1%) of 783 subjects without migraine aura and 33 (13.0%) of 254 subjects with migraine aura had NDE (p < 0.001, odds ratio (OR) = 2.29). In multiple logistic regression analysis, migraine aura remained significant after adjustment for age (p < 0.001, OR = 2.31), gender (p < 0.001, OR = 2.33), or both (p < 0.001, OR = 2.33).

Conclusions

In our sample, migraine aura was a predictor of NDE. This indirectly supports the association between NDE and REM intrusion and might have implications for the understanding of NDE, because a variant of spreading depolarization (SD), terminal SD, occurs in humans at the end of life, while a short-lasting variant of SD is considered the pathophysiological correlate of migraine aura.

Prevalence of near-death experiences in people with and without REM sleep intrusion

Background

The origin and prevalence of near-death experiences are unknown. A recent study suggested a link with REM sleep intrusion but was criticized for its selection of control participants. We therefore assessed the association of REM intrusion and near-death experiences with different methods.

Methods

Using a crowd-sourcing platform, we recruited 1,034 lay people from 35 countries to investigate the prevalence of near-death experiences and self-reported REM sleep intrusion. Reports were validated using the Greyson Near-Death Experiences Scale (GNDES) with ≥7 points as cut-off for near-death experiences.

Results

Near-death experiences were reported by 106 of 1,034 participants (10%; 95% CI [8.5–12%]). Evidence of REM intrusion was more common in people with near-death experiences (n = 50∕106; 47%) than in people with experiences with 6 points or less on the GNDES (n = 47∕183; 26%) or in those without such experiences (n = 107∕744; 14%; p =  < 0.0001). Following multivariate regression analysis to adjust for age, gender, place of residence, employment and perceived danger, this association remained highly significant; people with REM intrusion were more likely to exhibit near-death experiences than those without (OR 2.85; 95% CI [1.68–4.88]; p = 0.0001).

Discussion

Using a crowd-sourcing approach, we found a prevalence of near-death experiences of 10%. While age, gender, place of residence, employment status and perceived threat do not seem to influence the prevalence of near-death experiences, we confirmed a possible association with REM sleep intrusion.

Semiology and Mechanisms of Near-Death Experiences

PURPOSE OF REVIEW

Near-death experiences (NDEs) are conscious perceptual experiences, including self-related emotional, spiritual, and mystical experiences, occurring in close encounters with death or in non-life-threatening situations. The origin of NDEs remains unknown. Here, we review recent advances in the understanding of NDE semiology and pathophysiology.

RECENT FINDINGS

Recent prospective studies confirm that NDEs reflect a spectrum of highly distinctive memories which are associated with negative or positive emotions and can be influenced by the nature of the causal event, but the temporal sequence with which these images unfold is variable. Some drugs, notably ketamine, may lead to experiences that are similar or even identical to NDEs. New models extend previous neural network theories and include aspects of evolutionary and quantum theories. Although the factual existence of NDEs is no longer doubted and the semiology well-described, a pathophysiological model that includes all aspects of NDEs is still lacking.

Re A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological (brainstem) death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A (A Child) [2015] EWHC 443 (Fam). Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions. We argue that: (1) the tests of brainstem function were not properly undertaken in this case; (2) the two conjunctive clinical criteria set forth in the code of practice cannot be reliably confirmed by these tests in any event; and (3) absent authentication of the clinical criteria of death, the code of practice (in fact, although implicitly rather than explicitly) wrongly invokes a secular definition of death based on the loss of personhood. Consequently, the moral obligation of a pluralistic society to honor and respect diverse religious convictions to the greatest extent possible is being violated. Re A (A Child) is contrasted with the US case of Jahi McMath in which the court accommodated parental religious objection to the determination of neurological death codified in the Uniform Determination of Death Act. We conclude that the legal system in the United Kingdom should not favour a secular definition of death over a definition of death that is respectful of religious values about the inviolability and sanctity of life. We recommend the legal recognition of religious accommodation in death determination to facilitate cultural sensitivity and compassionate care to patients and families in a pluralistic society.

Development of the Italian Version of the Near-Death Experience Scale

Near-death experiences (NDEs) have been defined as any conscious perceptual experience occurring in individuals pronounced clinically dead or who came very close to physical death. They are frequently reported by patients surviving a critical injury and, intriguingly, they show common features across different populations. The tool traditionally used to assess NDEs is the NDE Scale, which is available in the original English version. The aim of this study was to develop the Italian version of the NDE Scale and to assess its reliability in a specific clinical setting. A process of translation of the original scale was performed in different stages in order to obtain a fully comprehensible and accurate Italian translation. Later, the scale was administered to a convenience sample of patients who had experienced a condition of coma and were, at the time of assessment, fully conscious and able to provide information as requested by the scale. Inter-rater and test–retest reliability, assessed by the weighted Cohen’s kappa (K_w), were estimated. A convenience sample of 20 subjects [mean age ± standard deviation (SD) 51.6 ± 17.1, median time from injury 3.5 months, interquartile range (IQR) 2–10] was included in the study. Inter-rater [K_w 0.77 (95% CI 0.67–0.87)] and test–retest reliability [K_w 0.96 (95% CI 0.91–1.00)] showed good to excellent values for the total scores of the Italian NDE Scale and for subanalyses of each single cluster of the scale. An Italian Version of the NDE Scale is now available to investigate the frequency of NDE, the causes for NDE heterogeneity across different life-threatening conditions, and the possible neural mechanisms underlying NDE phenomenology.