Comment on "Preserved feedforward but impaired top-down processes in the vegetative state"

Lateral frontoparietal effective connectivity differentiates and predicts state of consciousness in a cohort of patients with traumatic disorders of consciousness

Neuroimaging studies have suggested an important role for the default mode network (DMN) in disorders of consciousness (DoC). However, the extent to which DMN connectivity can discriminate DoC states-unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS)-is less evident. Particularly, it is unclear whether effective DMN connectivity, as measured indirectly with dynamic causal modelling (DCM) of resting EEG can disentangle UWS from healthy controls and from patients considered conscious (MCS+). Crucially, this extends to UWS patients with potentially "covert" awareness (minimally conscious star, MCS*) indexed by voluntary brain activity in conjunction with partially preserved frontoparietal metabolism as measured with positron emission tomography (PET+ diagnosis; in contrast to PET- diagnosis with complete frontoparietal hypometabolism). Here, we address this gap by using DCM of EEG data acquired from patients with traumatic brain injury in 11 UWS (6 PET- and 5 PET+) and in 12 MCS+ (11 PET+ and 1 PET-), alongside with 11 healthy controls. We provide evidence for a key difference in left frontoparietal connectivity when contrasting UWS PET- with MCS+ patients and healthy controls. Next, in a leave-one-subject-out cross-validation, we tested the classification performance of the DCM models demonstrating that connectivity between medial prefrontal and left parietal sources reliably discriminates UWS PET- from MCS+ patients and controls. Finally, we illustrate that these models generalize to an unseen dataset: models trained to discriminate UWS PET- from MCS+ and controls, classify MCS* patients as conscious subjects with high posterior probability (pp > .92). These results identify specific alterations in the DMN after severe brain injury and highlight the clinical utility of EEG-based effective connectivity for identifying patients with potential covert awareness.

The Role of Top-Down Modulation in Shaping Sensory Processing Across Brain States: Implications for Consciousness

Top-down, feedback projections account for a large portion of all connections between neurons in the thalamocortical system, yet their precise role remains the subject of much discussion. A large number of studies has focused on investigating how sensory information is transformed across hierarchically-distributed processing stages in a feedforward fashion, and computational models have shown that purely feedforward artificial neural networks can even outperform humans in pattern classification tasks. What is then the functional role of feedback connections? Several key roles have been identified, ranging from attentional modulation to, crucially, conscious perception. Specifically, most of the major theories on consciousness postulate that feedback connections would play an essential role in enabling sensory information to be consciously perceived. Consequently, it follows that their efficacy in modulating target regions should drastically decrease in nonconscious brain states [non-rapid eye movement (REM) sleep, anesthesia] compared to conscious ones (wakefulness), and also in instances when a given sensory stimulus is not perceived compared to when it is. Until recently, however, this prediction could only be tested with correlative experiments, due to the lack of techniques to selectively manipulate and measure the activity of feedback pathways. In this article, we will review the most recent literature on the functions of feedback connections across brain states and based on the presence or absence of perception. We will focus on experiments studying mismatch negativity, a phenomenon which has been hypothesized to rely on top-down modulation but which persists during nonconscious states. While feedback modulation is generally dampened in nonconscious states and enhanced when perception occurs, there are clear deviations from this rule. As we will discuss, this may pose a challenge to most theories of consciousness, and possibly require a change in how the level of consciousness in supposedly nonconscious states is assessed.

Normal Brain Response to Propofol in Advance of Recovery from Unresponsive Wakefulness Syndrome

Up to 40% of individuals with unresponsive wakefulness syndrome (UWS) actually might be conscious. Recent attempts to detect covert consciousness in behaviorally unresponsive patients via neurophysiological patterns are limited by the need to compare data from brain-injured patients to healthy controls. In this report, we pilot an alternative within-subject approach by using propofol to perturb the brain state of a patient diagnosed with UWS. An auditory stimulation series was presented to the patient before, during, and after exposure to propofol while high-density electroencephalograph (EEG) was recorded. Baseline analysis revealed residual markers in the continuous EEG and event-related potentials (ERPs) that have been associated with conscious processing. However, these markers were significantly distorted by the patient’s pathology, challenging the interpretation of their functional significance. Upon exposure to propofol, changes in EEG characteristics were similar to what is seen in healthy individuals and ERPs associated with conscious processing disappeared. At the 1-month follow up, the patient had regained consciousness. We offer three alternative explanations for these results: (1) the patient was covertly consciousness, and was anesthetized by propofol administration; (2) the patient was unconscious, and the observed EEG changes were a propofol-specific phenomenon; and (3) the patient was unconscious, but his brain networks responded normally in a way that heralded the possibility of recovery. These alternatives will be tested in a larger study, and raise the intriguing possibility of using a general anesthetic as a probe of brain states in behaviorally unresponsive patients.

Facilitative effect of repetitive presentation of one stimulus on cortical responses to other stimuli in macaque monkeys--a possible neural mechanism for mismatch negativity

The event-related potential 'mismatch negativity' (MMN) is an indicator of a perceiver's ability to detect deviations in sensory signal streams. MMN and its homologue in animals, mismatch activity (MMA), are differential neural responses to a repeatedly presented stimulus and a subsequent deviant stimulus (oddball). Because neural mechanisms underlying MMN and MMA remain unclear, there is a controversy as to whether MMN and MMA arise solely from stimulus-specific adaptation (SSA), in which the response to a stimulus cumulatively attenuates with its repetitive presentation. To address this issue, we used electrocorticography and the auditory roving-oddball paradigm in two awake macaque monkeys. We examined the effect of stimulus repetition number on MMA and on responses to repeated stimuli and oddballs across the cerebral cortex in the time-frequency domain. As the repetition number increased, MMA spread across the temporal, frontal and parietal cortices, and each electrode yielded a larger MMA. Surprisingly, this increment in MMA largely depended on response augmentation to the oddball rather than on SSA to the repeated stimulus. Following sufficient repetition, the oddball evoked a spectral power increment in some electrodes on the frontal cortex that had shown no power increase to the stimuli with less or no preceding repetition. We thereby revealed that repetitive presentation of one stimulus not only leads to SSA but also facilitates the cortical response to oddballs involving a wide range of cortical regions. This facilitative effect might underlie the generation of MMN-like scalp potentials in macaques that potentially shares similar neural mechanisms with MMN in humans.

How does the extraction of local and global auditory regularities vary with context?

How does the human brain extract regularities from its environment? There is evidence that short range or ‘local’ regularities (within seconds) are automatically detected by the brain while long range or ‘global’ regularities (over tens of seconds or more) require conscious awareness. In the present experiment, we asked whether participants' attention was needed to acquire such auditory regularities, to detect their violation or both. We designed a paradigm in which participants listened to predictable sounds. Subjects could be distracted by a visual task at two moments: when they were first exposed to a regularity or when they detected violations of this regularity. MEG recordings revealed that early brain responses (100–130 ms) to violations of short range regularities were unaffected by visual distraction and driven essentially by local transitional probabilities. Based on global workspace theory and prior results, we expected that visual distraction would eliminate the long range global effect, but unexpectedly, we found the contrary, i.e. late brain responses (300–600 ms) to violations of long range regularities on audio-visual trials but not on auditory only trials. Further analyses showed that, in fact, visual distraction was incomplete and that auditory and visual stimuli interfered in both directions. Our results show that conscious, attentive subjects can learn the long range dependencies present in auditory stimuli even while performing a visual task on synchronous visual stimuli. Furthermore, they acquire a complex regularity and end up making different predictions for the very same stimulus depending on the context (i.e. absence or presence of visual stimuli). These results suggest that while short-range regularity detection is driven by local transitional probabilities between stimuli, the human brain detects and stores long-range regularities in a highly flexible, context dependent manner.