Consciousness Detection in a Complete Locked-in Syndrome Patient through Multiscale Approach Analysis

Altered brain dynamics index levels of arousal in complete locked-in syndrome

Complete locked-in syndrome (CLIS) resulting from late-stage amyotrophic lateral sclerosis (ALS) is characterised by loss of motor function and eye movements. The absence of behavioural indicators of consciousness makes the search for neuronal correlates as possible biomarkers clinically and ethically urgent. EEG-based measures of brain dynamics such as power-law exponent (PLE) and Lempel-Ziv complexity (LZC) have been shown to have explanatory power for consciousness and may provide such neuronal indices for patients with CLIS. Here, we validated PLE and LZC (calculated in a dynamic way) as benchmarks of a wide range of arousal states across different reference states of consciousness (e.g., awake, sleep stages, ketamine, sevoflurane). We show a tendency toward high PLE and low LZC, with high intra-subject fluctuations and inter-subject variability in a cohort of CLIS patients with values graded along different arousal states as in our reference data sets. In conclusion, changes in brain dynamics indicate altered arousal in CLIS. Specifically, PLE and LZC are potentially relevant biomarkers to identify or diagnose the arousal level in CLIS and to determine the optimal time point for treatment, including communication attempts.

State-of-the-Art on Brain-Computer Interface Technology

This paper provides a comprehensive overview of the state-of-the-art in brain-computer interfaces (BCI). It begins by providing an introduction to BCIs, describing their main operation principles and most widely used platforms. The paper then examines the various components of a BCI system, such as hardware, software, and signal processing algorithms. Finally, it looks at current trends in research related to BCI use for medical, educational, and other purposes, as well as potential future applications of this technology. The paper concludes by highlighting some key challenges that still need to be addressed before widespread adoption can occur. By presenting an up-to-date assessment of the state-of-the-art in BCI technology, this paper will provide valuable insight into where this field is heading in terms of progress and innovation.

Nine decades of electrocorticography: A comparison between epidural and subdural recordings

In recent years, electrocorticography (ECoG) has arisen as a neural signal recording tool in the development of clinically viable neural interfaces. ECoG electrodes are generally placed below the dura mater (subdural) but can also be placed on top of the dura (epidural). In deciding which of these modalities best suits long-term implants, complications and signal quality are important considerations. Conceptually, epidural placement may present a lower risk of complications as the dura is left intact but also a lower signal quality due to the dura acting as a signal attenuator. The extent to which complications and signal quality are affected by the dura, however, has been a matter of debate. To improve our understanding of the effects of the dura on complications and signal quality, we conducted a literature review. We inventorized the effect of the dura on signal quality, decodability and longevity of acute and chronic ECoG recordings in humans and non-human primates. Also, we compared the incidence and nature of serious complications in studies that employed epidural and subdural ECoG. Overall, we found that, even though epidural recordings exhibit attenuated signal amplitude over subdural recordings, particularly for high-density grids, the decodability of epidural recorded signals does not seem to be markedly affected. Additionally, we found that the nature of serious complications was comparable between epidural and subdural recordings. These results indicate that both epidural and subdural ECoG may be suited for long-term neural signal recordings, at least for current generations of clinical and high-density ECoG grids.

Locked-in syndrome revisited

The locked-in syndrome (LiS) is characterized by quadriplegia with preserved vertical eye and eyelid movements and retained cognitive abilities. Subcategorization, aetiologies and the anatomical foundation of LiS are discussed. The damage of different structures in the pons, mesencephalon and thalamus are attributed to symptoms of classical, complete and incomplete LiS and the locked-in plus syndrome, which is characterized by additional impairments of consciousness, making the clinical distinction to other chronic disorders of consciousness at times difficult. Other differential diagnoses are cognitive motor dissociation (CMD) and akinetic mutism. Treatment options are reviewed and an early, interdisciplinary and aggressive approach, including the provision of psychological support and coping strategies is favoured. The establishment of communication is a main goal of rehabilitation. Finally, the quality of life of LiS patients and ethical implications are considered. While patients with LiS report a high quality of life and well-being, medical professionals and caregivers have largely pessimistic perceptions. The negative view on life with LiS must be overthought and the autonomy and dignity of LiS patients prioritized. Knowledge has to be disseminated, diagnostics accelerated and technical support system development promoted. More well-designed research but also more awareness of the needs of LiS patients and their perception as individual persons is needed to enable a life with LiS that is worth living.

Application of Soft-Clustering to Assess Consciousness in a CLIS Patient

Completely locked-in (CLIS) patients are characterized by sufficiently intact cognitive functions, but a complete paralysis that prevents them to interact with their surroundings. On one hand, studies have shown that the ability to communicate plays an important part in these patients' quality of life and prognosis. On the other hand, brain-computer interfaces (BCIs) provide a means for them to communicate using their brain signals. However, one major problem for such patients is the difficulty to determine if they are conscious or not at a specific time. This work aims to combine different sets of features consisting of spectral, complexity and connectivity measures, to increase the probability of correctly estimating CLIS patients' consciousness levels. The proposed approach was tested on data from one CLIS patient, which is particular in the sense that the experimenter was able to point out one time frame Δt during which he was undoubtedly conscious. Results showed that the method presented in this paper was able to detect increases and decreases of the patient's consciousness levels. More specifically, increases were observed during this Δt, corroborating the assertion of the experimenter reporting that the patient was definitely conscious then. Assessing the patients' consciousness is intended as a step prior attempting to communicate with them, in order to maximize the efficiency of BCI-based communication systems.

Neuroscience of consciousness in the locked-in syndrome: Prognostic and diagnostic review

The neurological illness known as a locked-in syndrome is brought on by damage to the brainstem, usually as a consequence of a stroke. It is characterized by total paralysis with intact consciousness and cognitive capacity. The subjective experiences of people with locked-in syndrome are poorly understood. Presently, there is no systematic evaluation developed to describe them. The most compelling resources come from individuals' own words; however, only a small fraction of these accounts have been explored. When it comes to bioethics, locked-in syndrome protocols are almost completely absent. Investigations on how people with this condition feel about their sense of continuity are of importance. Utilizing the locked-in syndrome to pose questions on embodied cognition and levels of consciousness could serve as a lens through which to examine problems in the phenomenology of neuroparalysis and communication. Care and quality of patients' lives might be improved by an effort to understand this condition better, and ontological questions like "what makes a person a person?," "what makes a person appear in continuity?," and "what are the dynamics of embodiment and intersubjectivity?" might be better explored through that lens. This article aims to explore some biomedical factors that contribute to locked-in syndrome and offers some prognostic and diagnostic recommendations for this rare condition.

Consciousness and complexity: a consilience of evidence

Over the last years, a surge of empirical studies converged on complexity-related measures as reliable markers of consciousness across many different conditions, such as sleep, anesthesia, hallucinatory states, coma, and related disorders. Most of these measures were independently proposed by researchers endorsing disparate frameworks and employing different methods and techniques. Since this body of evidence has not been systematically reviewed and coherently organized so far, this positive trend has remained somewhat below the radar. The aim of this paper is to make this consilience of evidence in the science of consciousness explicit. We start with a systematic assessment of the growing literature on complexity-related measures and identify their common denominator, tracing it back to core theoretical principles and predictions put forward more than 20 years ago. In doing this, we highlight a consistent trajectory spanning two decades of consciousness research and provide a provisional taxonomy of the present literature. Finally, we consider all of the above as a positive ground to approach new questions and devise future experiments that may help consolidate and further develop a promising field where empirical research on consciousness appears to have, so far, naturally converged.