1
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Barami K. Confounding factors impacting the Glasgow coma score: a literature review. Neurol Res 2024; 46:479-486. [PMID: 38497232 DOI: 10.1080/01616412.2024.2329860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The Glasgow coma score (GCS) is a clinical tool used to measure level of consciousness in traumatic brain injury and other settings. Despite its widespread use, there are many inaccuracies in its reporting. One source of inaccuracy is confounding factors which affect consciousness as well as each sub-score of the GCS. The purpose of this article was to create a comprehensive list of confounding factors in order to improve the accuracy of the GCS and ultimately improve decision-making. METHODS An English language literature search was conducted discussing GCS and multiple other keywords. Ultimately, 64 out of 3972 articles were included for further analysis. RESULTS A multitude of confounding factors were identified which may affect consciousness or GCS sub-scores including the eye exam, motor exam and the verbal response. CONCLUSIONS An up-to-date comprehensive list of confounding factors has been created that may be used to aide in GCS recording in hopes of improving its accuracy and utility.
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Affiliation(s)
- Kaveh Barami
- St. Francis Hospital, Trinity Health of New England, Hartford, CT, USA
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2
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Fu Y, Zhou M, Zhou J, Shen M, Chen H. Unconscious prioritization for face-to-face people. J Exp Psychol Gen 2024; 153:1268-1280. [PMID: 38647479 DOI: 10.1037/xge0001556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
One central question in the scientific and philosophical study of consciousness is regarding the scope of human consciousness. There is a lively debate as to whether high-level information integration is necessarily dependent on consciousness. This study presents a new form of unconscious integration based on the facingness between two individuals. Using a breaking continuous flash suppression paradigm, Experiments 1-3 found that two facing human heads got a privilege in breaking into awareness compared to nonfacing pairs. Experiments 4 and 5 demonstrated that the breakthrough difference between facing and nonfacing pairs could not be attributed to low-level or mid-level factors. Experiments 6, 7a, and 7b showed that the unconscious priority of facing pairs was significantly diminished when the holistic processing of the two agents was disrupted. Experiments 8-11 demonstrated that the advantage of facing pairs was only observable for human agents and not for daily objects, directional arrows, or nonhuman animals. These findings have critical implications for better understanding the scope of human consciousness and the origins of social vision. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Yingtao Fu
- Zhejiang University, Department of Psychology and Behavioral Sciences
| | - Mei Zhou
- Zhejiang University, Department of Psychology and Behavioral Sciences
| | - Jifan Zhou
- Zhejiang University, Department of Psychology and Behavioral Sciences
| | - Mowei Shen
- Zhejiang University, Department of Psychology and Behavioral Sciences
| | - Hui Chen
- Zhejiang University, Department of Psychology and Behavioral Sciences
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3
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Toplutaş E, Aydın F, Hanoğlu L. EEG Microstate Analysis in Patients with Disorders of Consciousness and Its Clinical Significance. Brain Topogr 2024; 37:377-387. [PMID: 36735192 DOI: 10.1007/s10548-023-00939-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Abstract
Disorders of Consciousness are divided into two major categories such as vegetative and minimally conscious states. Objective measures that allow correct identification of patients with vegetative and minimally conscious state are needed. EEG microstate analysis is a promising approach that we believe has the potential to be effective in examining the resting state activities of the brain in different stages of consciousness by allowing the proper identification of vegetative and minimally conscious patients. As a result, we try to identify clinical evaluation scales and microstate characteristics with resting state EEGs from individuals with disorders of consciousness. Our prospective observational study included 28 individuals with a disorder of consciousness. Control group included 18 healthy subjects with proper EEG data. We made clinical evaluations using patient behavior scales. We also analyzed the EEGs using microstate analysis. In our study, microstate D coverage differed substantially between vegetative and minimally conscious state patients. Also, there was a strong connection between microstate D characteristics and clinical scale scores. Consequently, we have demonstrated that the most accurate parameter for representing consciousness level is microstate D. Microstate analysis appears to be a strong option for future use in the diagnosis, follow-up, and treatment response of patients with Disorders of Consciousness.
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Affiliation(s)
- Eren Toplutaş
- Department of Neurology, Istanbul Eyupsultan Public Hospital, Istanbul, Turkey.
- Program of Neuroscience Ph.D., Graduate School of Health Sciences,, Istanbul Medipol University, Istanbul, Turkey.
| | - Fatma Aydın
- Program of Neuroscience Ph.D., Graduate School of Health Sciences,, Istanbul Medipol University, Istanbul, Turkey
| | - Lütfü Hanoğlu
- Department of Neurology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Neuroimaging and Neuromodulation Lab, Clinical Electrophysiology, REMER, Istanbul Medipol University, Istanbul, Turkey
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4
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Charbonneau JA, Santistevan AC, Raven EP, Bennett JL, Russ BE, Bliss-Moreau E. Evolutionarily conserved neural responses to affective touch in monkeys transcend consciousness and change with age. Proc Natl Acad Sci U S A 2024; 121:e2322157121. [PMID: 38648473 DOI: 10.1073/pnas.2322157121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/05/2024] [Indexed: 04/25/2024] Open
Abstract
Affective touch-a slow, gentle, and pleasant form of touch-activates a different neural network than which is activated during discriminative touch in humans. Affective touch perception is enabled by specialized low-threshold mechanoreceptors in the skin with unmyelinated fibers called C tactile (CT) afferents. These CT afferents are conserved across mammalian species, including macaque monkeys. However, it is unknown whether the neural representation of affective touch is the same across species and whether affective touch's capacity to activate the hubs of the brain that compute socioaffective information requires conscious perception. Here, we used functional MRI to assess the preferential activation of neural hubs by slow (affective) vs. fast (discriminative) touch in anesthetized rhesus monkeys (Macaca mulatta). The insula, anterior cingulate cortex (ACC), amygdala, and secondary somatosensory cortex were all significantly more active during slow touch relative to fast touch, suggesting homologous activation of the interoceptive-allostatic network across primate species during affective touch. Further, we found that neural responses to affective vs. discriminative touch in the insula and ACC (the primary cortical hubs for interoceptive processing) changed significantly with age. Insula and ACC in younger animals differentiated between slow and fast touch, while activity was comparable between conditions for aged monkeys (equivalent to >70 y in humans). These results, together with prior studies establishing conserved peripheral nervous system mechanisms of affective touch transduction, suggest that neural responses to affective touch are evolutionarily conserved in monkeys, significantly impacted in old age, and do not necessitate conscious experience of touch.
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Affiliation(s)
- Joey A Charbonneau
- Neuroscience Graduate Program, University of California, Davis, CA 95616
- Neuroscience and Behavior Unit, California National Primate Research Center, University of California, Davis, CA 95616
| | - Anthony C Santistevan
- Neuroscience and Behavior Unit, California National Primate Research Center, University of California, Davis, CA 95616
- Department of Psychology, University of California, Davis, CA 95616
| | - Erika P Raven
- Department of Radiology, Center for Biomedical Imaging, New York University Grossman School of Medicine, New York, NY 10016
| | - Jeffrey L Bennett
- Neuroscience and Behavior Unit, California National Primate Research Center, University of California, Davis, CA 95616
- Department of Psychology, University of California, Davis, CA 95616
- Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine, Sacramento, CA 95817
- The Medical Investigation of Neurodevelopmental Disorders Institute, University of California, Sacramento, CA 95817
| | - Brian E Russ
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute, Orangeburg, NY 10962
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Psychiatry, New York University Langone, New York, NY 10016
| | - Eliza Bliss-Moreau
- Neuroscience and Behavior Unit, California National Primate Research Center, University of California, Davis, CA 95616
- Department of Psychology, University of California, Davis, CA 95616
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5
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Hruby H, Schmidt S, Feinstein JS, Wittmann M. Induction of altered states of consciousness during Floatation-REST is associated with the dissolution of body boundaries and the distortion of subjective time. Sci Rep 2024; 14:9316. [PMID: 38654027 DOI: 10.1038/s41598-024-59642-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
Floatation-REST (Reduced Environmental Stimulation Therapy) minimizes stimulation of the nervous system by immersing subjects in an environment without sound or light while they effortlessly float in thermoneutral water supersaturated with Epsom salt. Here we investigated the relationship between altered states of consciousness (ASC) and its association with the affective changes induced by Floatation-REST. Using a within-subject crossover design, 50 healthy subjects were randomized to 60 min of Floatation-REST or 60 min of Bed-REST (an active control condition that entailed lying supine on a warm waterbed in a dark and quiet room). Following Floatation-REST, subjects felt significantly more relaxed, less anxious, and less tired than after Bed-REST. Floatation-REST also induced significantly more pronounced ASC characterized by the dissolution of body boundaries and the distortion of subjective time. The loss of body boundaries mediated the loss of anxiety, revealing a novel mechanism by which Floatation-REST exerts its anxiolytic effect.
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Affiliation(s)
- Helena Hruby
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany.
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | | | - Marc Wittmann
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany.
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Salvesen L, Capriglia E, Dresler M, Bernardi G. Influencing dreams through sensory stimulation: A systematic review. Sleep Med Rev 2024; 74:101908. [PMID: 38417380 PMCID: PMC11009489 DOI: 10.1016/j.smrv.2024.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Abstract
Sleep is typically considered a state of disconnection from the environment, yet instances of external sensory stimuli influencing dreams have been reported for centuries. Explaining this phenomenon could provide valuable insight into dreams' generative and functional mechanisms, the factors that promote sleep continuity, and the processes that underlie conscious awareness. Moreover, harnessing sensory stimuli for dream engineering could benefit individuals suffering from dream-related alterations. This PRISMA-compliant systematic review assessed the current evidence concerning the influence of sensory stimulation on sleep mentation. We included 51 publications, of which 21 focused on auditory stimulation, ten on somatosensory stimulation, eight on olfactory stimulation, four on visual stimulation, two on vestibular stimulation, and one on multimodal stimulation. Furthermore, nine references explored conditioned associative stimulation: six focused on targeted memory reactivation protocols and three on targeted lucid reactivation protocols. The reported frequency of stimulus-dependent dream changes across studies ranged from 0 to ∼80%, likely reflecting a considerable heterogeneity of definitions and methodological approaches. Our findings highlight a lack of comprehensive understanding of the mechanisms, functions, and neurophysiological correlates of stimulus-dependent dream changes. We suggest that a paradigm shift is required for meaningful progress in this field.
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Affiliation(s)
- Leila Salvesen
- Sleep, Plasticity, and Conscious Experience Group, MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Elena Capriglia
- Sleep, Plasticity, and Conscious Experience Group, MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Giulio Bernardi
- Sleep, Plasticity, and Conscious Experience Group, MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy.
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7
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Moretta P, Femiano C, Cavallo ND, Lanzillo A, Luciano F, Ferrante C, Maiorino A, Santangelo G, Marcuccio L. Family caregivers improve the diagnostic accuracy of disorders of consciousness: from remote to near-bed auditory stimulation. Eur J Phys Rehabil Med 2024; 60:198-206. [PMID: 38381451 DOI: 10.23736/s1973-9087.24.08179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Family caregivers (FC) contribute to reducing the misdiagnosis rate in patients with disorders of consciousness (DOC). Unfortunately, the recent pandemic of COVID-19 imposed drastic restrictions that limited the access of FC to the sensory/cognitive stimulation protocols. Telemedicine approaches have been implemented to avoid discontinuity in care pathways and to ensure caregivers involvement in rehabilitation programs. AIM The aim was to investigate whether the presence of FC remotely connected might help clinicians in eliciting higher cortically mediated behavioral responses in patients with DOC. DESIGN Cross-sectional study. SETTING Post-acute Unit of Neurorehabilitation. POPULATION DOC due to severe brain injury. METHODS Consecutive patients with DOC were assessed by means of the Coma Recovery Scale-Revised (CRS-R) by two expert examiners. Each patient underwent to five assessments in two weeks in three different conditions: 1) by the examiner only (standard); 2) with the verbal stimulation given by the FC remotely connected by PC tablet (caregiver in remote); and 3) with the verbal stimulation given by the FC physically present (caregiver in presence). RESULTS Thirty patients with DOC (VS/UWS=10; MCS=20; mean age: 51, range: 21-79; vascular: 16; anoxic: 6; TBI=8) and their FC were enrolled. Higher total scores of CRS-R were recorded both in "caregiver in remote" and in "caregiver in presence" than in standard condition (standard vs. remote, Z=2.942, P=0.003; standard vs. presence, Z=3.736, P<0.001). Furthermore, the administration of the CRS-R with a FC, elicited higher levels of behavioral responses in MCS patients, than CRS-R performed in standard condition. In particular, 2 patients out of 30 (6.66%) showed higher scores and better diagnosis when the CRS-R was administered with FC in remote. Similarly, 5 out of 30 patients (16.66%) showed better diagnoses when the CRS-R was administered with FC in presence. Five patients changed diagnosis between standard and presence conditions (3 MCS- were diagnosed as MCS+; 2 MCS+ were diagnosed as conscious). CONCLUSIONS Our findings add new evidence regarding the beneficial role of family members in the diagnosis of DOC, even mediated by telemedicine approach. CLINICAL REHABILITATION IMPACT In future guidelines, FC should have an active and supporting role in the diagnostic and rehabilitative process of DOC.
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Affiliation(s)
- Pasquale Moretta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy -
| | - Cinzia Femiano
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Nicola D Cavallo
- Department of Psychology, Luigi Vanvitelli University of Campania, Caserta, Italy
| | - Anna Lanzillo
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Fabrizio Luciano
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Cesario Ferrante
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Antonio Maiorino
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
| | - Gabriella Santangelo
- Department of Psychology, Luigi Vanvitelli University of Campania, Caserta, Italy
| | - Laura Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme, Telese Terme, Benevento, Italy
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Luppi AI, Uhrig L, Tasserie J, Signorelli CM, Stamatakis EA, Destexhe A, Jarraya B, Cofre R. Local orchestration of distributed functional patterns supporting loss and restoration of consciousness in the primate brain. Nat Commun 2024; 15:2171. [PMID: 38462641 PMCID: PMC10925605 DOI: 10.1038/s41467-024-46382-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
A central challenge of neuroscience is to elucidate how brain function supports consciousness. Here, we combine the specificity of focal deep brain stimulation with fMRI coverage of the entire cortex, in awake and anaesthetised non-human primates. During propofol, sevoflurane, or ketamine anaesthesia, and subsequent restoration of responsiveness by electrical stimulation of the central thalamus, we investigate how loss of consciousness impacts distributed patterns of structure-function organisation across scales. We report that distributed brain activity under anaesthesia is increasingly constrained by brain structure across scales, coinciding with anaesthetic-induced collapse of multiple dimensions of hierarchical cortical organisation. These distributed signatures are observed across different anaesthetics, and they are reversed by electrical stimulation of the central thalamus, coinciding with recovery of behavioural markers of arousal. No such effects were observed upon stimulating the ventral lateral thalamus, demonstrating specificity. Overall, we identify consistent distributed signatures of consciousness that are orchestrated by specific thalamic nuclei.
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Affiliation(s)
- Andrea I Luppi
- Division of Anaesthesia and Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
| | - Lynn Uhrig
- Cognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Saclay, NeuroSpin Center, 91191, Gif-sur-Yvette, France
- Department of Anesthesiology and Critical Care, Necker Hospital, AP-HP, Université de Paris Cité, Paris, France
| | - Jordy Tasserie
- Cognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Saclay, NeuroSpin Center, 91191, Gif-sur-Yvette, France
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Camilo M Signorelli
- Cognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Saclay, NeuroSpin Center, 91191, Gif-sur-Yvette, France
- Laboratory of Neurophysiology and Movement Biomechanics, Université Libre de Bruxelles, 1070, Brussels, Belgium
- Department of Computer Science, University of Oxford, Oxford, 7 Parks Rd, Oxford, OX1 3QG, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia and Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Alain Destexhe
- Institute of Neuroscience (NeuroPSI), Paris-Saclay University, Centre National de la Recherche Scientifique (CNRS), Gif-sur-Yvette, France
| | - Bechir Jarraya
- Cognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Saclay, NeuroSpin Center, 91191, Gif-sur-Yvette, France
- Department of Neurology, Hopital Foch, 92150, Suresnes, France
| | - Rodrigo Cofre
- Institute of Neuroscience (NeuroPSI), Paris-Saclay University, Centre National de la Recherche Scientifique (CNRS), Gif-sur-Yvette, France.
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Torday JS. The holism of evolution as consciousness. Prog Biophys Mol Biol 2024; 187:5-8. [PMID: 38296164 DOI: 10.1016/j.pbiomolbio.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
Quantum Entanglement has been hypothesized to mediate non-local consciousness, underlying which, empirically, is the force of gravity. Upon further reflection, the case can be made for 'the breath' as the physiologic trait that binds all of these properties together, offering further opportunity for hypothesis testing experimentation. Humans have inexplicably made extraordinary intellectual and technical advances within a relatively very short period of time, referred to as the 'great leap forward'. It would be of great value if we could identify how and why we have evolved so rapidly. There is a holotropism that begins with the Big Bang that is centered on the homeostatic control of energy, perpetually referencing the First Principles of Physiology. "The Breath" is how and why our physiology has managed to perpetuate our species, and perhaps why the lung has been 'over-engineered' in order to facilitate the role of breathing in consciousness.
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Affiliation(s)
- John S Torday
- Pediatrics, University of California, Los Angeles, USA.
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10
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Wu M, Concolato M, Sorger B, Yu Y, Li X, Luo B, Riecke L. Acoustic-electric trigeminal-nerve stimulation enhances functional connectivity in patients with disorders of consciousness. CNS Neurosci Ther 2024; 30:e14385. [PMID: 37525451 PMCID: PMC10928333 DOI: 10.1111/cns.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/29/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023] Open
Abstract
AIM Disruption of functional brain connectivity is thought to underlie disorders of consciousness (DOC) and recovery of impaired connectivity is suggested as an indicator of consciousness restoration. We recently found that rhythmic acoustic-electric trigeminal-nerve stimulation (i.e., musical stimulation synchronized to electrical stimulation of the trigeminal nerve) in the gamma band can improve consciousness in patients with DOC. Here, we investigated whether these beneficial stimulation effects are mediated by alterations in functional connectivity. METHODS Sixty-three patients with DOC underwent 5 days of gamma, beta, or sham acoustic-electric trigeminal-nerve stimulation. Resting-state electroencephalography was measured before and after the stimulation and functional connectivity was assessed using phase-lag index (PLI). RESULTS We found that gamma stimulation induces an increase in gamma-band PLI. Further characterization revealed that the enhancing effect is (i) specific to the gamma band (as we observed no comparable change in beta-band PLI and no effect of beta-band acoustic-electric stimulation or sham stimulation), (ii) widely spread across the cortex, and (iii) accompanied by improvements in patients' auditory abilities. CONCLUSION These findings show that gamma acoustic-electric trigeminal-nerve stimulation can improve resting-state functional connectivity in the gamma band, which in turn may be linked to auditory abilities and/or consciousness restoration in DOC patients.
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Affiliation(s)
- Min Wu
- Department of Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Marta Concolato
- Department of Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
- Department of Developmental Psychology and SocializationUniversity of PadovaPadovaItaly
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Yamei Yu
- Department of Neurology and Brain Medical Centre, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Xiaoxia Li
- Department of Neurology and Brain Medical Centre, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Lars Riecke
- Department of Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
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11
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Kaufmann A, Parmigiani S, Kawagoe T, Zabaroff E, Wells B. Two models of mind blanking. Eur J Neurosci 2024; 59:786-795. [PMID: 37778749 DOI: 10.1111/ejn.16164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/23/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
Mind blanking is a mental state in which attention does not bring any perceptual input into conscious awareness. As this state is still largely unexplored, we suggest that a comprehensive understanding of mind blanking can be achieved through a multifaceted approach combining self-assessment methods, neuroimaging and neuromodulation. In this article, we explain how electroencephalography and transcranial magnetic stimulation could be combined to help determine whether mind blanking is associated with a lack of mental content or a lack of linguistically or conceptually determinable mental content. We also question whether mind blanking occurs spontaneously or intentionally and whether these two forms are instantiated by the same or different neural correlates.
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Affiliation(s)
- Angelica Kaufmann
- Institut für Philosophie II, Ruhr-Universität Bochum, Bochum, Germany
- Mind and Cognition Lab, PhiLab, University of Milan, Milan, Italy
| | - Sara Parmigiani
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
- Mind and Cognition Lab, PhiLab, University of Milan, Milan, Italy
| | - Toshikazu Kawagoe
- School of Humanities and Science, Kyushu Campus, Tokai University, Kumamoto, Japan
| | - Elliot Zabaroff
- Mind and Cognition Lab, PhiLab, University of Milan, Milan, Italy
| | - Barnaby Wells
- Mind and Cognition Lab, PhiLab, University of Milan, Milan, Italy
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12
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Nichelli PF, Grafman J. The place of Free Will: the freedom of the prisoner. Neurol Sci 2024; 45:861-871. [PMID: 37870645 DOI: 10.1007/s10072-023-07138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
Debates about the concept of Free Will date back to ancient times. About 40 years ago, Benjamin Libet designed an experiment showing that the conscious intention to move is preceded by a specific pattern of brain activation. His finding suggested that unconscious processes determine our decisions. Libet-style experiments have continued to dominate the debate about Free Will, pushing some authors to argue that the existence of Free Will is a mere illusion. We believe that this dispute is because we often measure Free Will using arbitrary human decisions rather than deliberate actions. After reviewing the definition of Free Will and the related literature, we conclude that the scientific evidence does not disprove the existence of Free Will. However, our will encounters several constraints and limitations that should be considered when evaluating our deeds' personal responsibility.
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Affiliation(s)
- Paolo F Nichelli
- University of Modena and Reggio Emilia, Via Romolo Benzi, 48, 41126, Modena, Italy.
| | - Jordan Grafman
- Brain Injury Research, Cognitive Neuroscience Lab, Think and Speak Lab, 25th Floor, Northeast Corner, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611-5146, USA
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13
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Gallucci A, Varoli E, Del Mauro L, Hassan G, Rovida M, Comanducci A, Casarotto S, Lo Re V, Romero Lauro LJ. Multimodal approaches supporting the diagnosis, prognosis and investigation of neural correlates of disorders of consciousness: A systematic review. Eur J Neurosci 2024; 59:874-933. [PMID: 38140883 DOI: 10.1111/ejn.16149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 12/24/2023]
Abstract
The limits of the standard, behaviour-based clinical assessment of patients with disorders of consciousness (DoC) prompted the employment of functional neuroimaging, neurometabolic, neurophysiological and neurostimulation techniques, to detect brain-based covert markers of awareness. However, uni-modal approaches, consisting in employing just one of those techniques, are usually not sufficient to provide an exhaustive exploration of the neural underpinnings of residual awareness. This systematic review aimed at collecting the evidence from studies employing a multimodal approach, that is, combining more instruments to complement DoC diagnosis, prognosis and better investigating their neural correlates. Following the PRISMA guidelines, records from PubMed, EMBASE and Scopus were screened to select peer-review original articles in which a multi-modal approach was used for the assessment of adult patients with a diagnosis of DoC. Ninety-two observational studies and 32 case reports or case series met the inclusion criteria. Results highlighted a diagnostic and prognostic advantage of multi-modal approaches that involve electroencephalography-based (EEG-based) measurements together with neuroimaging or neurometabolic data or with neurostimulation. Multimodal assessment deepened the knowledge on the neural networks underlying consciousness, by showing correlations between the integrity of the default mode network and the different clinical diagnosis of DoC. However, except for studies using transcranial magnetic stimulation combined with electroencephalography, the integration of more than one technique in most of the cases occurs without an a priori-designed multi-modal diagnostic approach. Our review supports the feasibility and underlines the advantages of a multimodal approach for the diagnosis, prognosis and for the investigation of neural correlates of DoCs.
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Affiliation(s)
- Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Milan, Italy
| | - Erica Varoli
- Neurology Service, Department of Diagnostic and Therapeutic Services, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS ISMETT), Palermo, Italy
| | - Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Gabriel Hassan
- Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Margherita Rovida
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Angela Comanducci
- IRCSS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Università Campus Bio-Medico di Roma, Rome, Italy
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences, University of Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Vincenzina Lo Re
- Neurology Service, Department of Diagnostic and Therapeutic Services, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS ISMETT), Palermo, Italy
| | - Leonor J Romero Lauro
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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14
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Diezig S, Denzer S, Achermann P, Mast FW, Koenig T. EEG Microstate Dynamics Associated with Dream-Like Experiences During the Transition to Sleep. Brain Topogr 2024; 37:343-355. [PMID: 36402917 PMCID: PMC10884123 DOI: 10.1007/s10548-022-00923-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/21/2022] [Indexed: 11/21/2022]
Abstract
Consciousness always requires some representational content; that is, one can only be conscious about something. However, the presence of conscious experience (awareness) alone does not determine whether its content is in line with the external and physical world. Dreams, apart from certain forms of hallucinations, typically consist of non-veridical percepts, which are not recognized as false, but rather considered real. This type of experiences have been described as a state of dissociation between phenomenal and reflective awareness. Interestingly, during the transition to sleep, reflective awareness seems to break down before phenomenal awareness as conscious experience does not immediately fade with reduced wakefulness but is rather characterized by the occurrence of uncontrolled thinking and perceptual images, together with a reduced ability to recognize the internal origin of the experience. Relative deactivation of the frontoparietal and preserved activity in parieto-occipital networks has been suggested to account for dream-like experiences during the transition to sleep. We tested this hypothesis by investigating subjective reports of conscious experience and large-scale brain networks using EEG microstates in 45 healthy young subjects during the transition to sleep. We observed an inverse relationship between cognitive effects and physiological activation; dream-like experiences were associated with an increased presence of a microstate with sources in the superior and middle frontal gyrus and precuneus. Additionally, the presence of a microstate associated with higher-order visual areas was decreased. The observed inverse relationship might therefore indicate a disengagement of cognitive control systems that is mediated by specific, inhibitory EEG microstates.
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Affiliation(s)
- Sarah Diezig
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Simone Denzer
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Peter Achermann
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Fred W Mast
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Thomas Koenig
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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15
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Zhu Y, Li C, Hendry C, Glass J, Canseco-Gonzalez E, Pitts MA, Dykstra AR. Isolating Neural Signatures of Conscious Speech Perception with a No-Report Sine-Wave Speech Paradigm. J Neurosci 2024; 44:e0145232023. [PMID: 38191569 PMCID: PMC10883607 DOI: 10.1523/jneurosci.0145-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 11/21/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
Identifying neural correlates of conscious perception is a fundamental endeavor of cognitive neuroscience. Most studies so far have focused on visual awareness along with trial-by-trial reports of task-relevant stimuli, which can confound neural measures of perceptual awareness with postperceptual processing. Here, we used a three-phase sine-wave speech paradigm that dissociated between conscious speech perception and task relevance while recording EEG in humans of both sexes. Compared with tokens perceived as noise, physically identical sine-wave speech tokens that were perceived as speech elicited a left-lateralized, near-vertex negativity, which we interpret as a phonological version of a perceptual awareness negativity. This response appeared between 200 and 300 ms after token onset and was not present for frequency-flipped control tokens that were never perceived as speech. In contrast, the P3b elicited by task-irrelevant tokens did not significantly differ when the tokens were perceived as speech versus noise and was only enhanced for tokens that were both perceived as speech and relevant to the task. Our results extend the findings from previous studies on visual awareness and speech perception and suggest that correlates of conscious perception, across types of conscious content, are most likely to be found in midlatency negative-going brain responses in content-specific sensory areas.
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Affiliation(s)
- Yunkai Zhu
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida 33143
| | - Charlotte Li
- Department of Psychology, Reed College, Portland, Oregon 97202
| | - Camille Hendry
- Department of Psychology, Reed College, Portland, Oregon 97202
| | - James Glass
- Department of Psychology, Reed College, Portland, Oregon 97202
| | | | - Michael A Pitts
- Department of Psychology, Reed College, Portland, Oregon 97202
| | - Andrew R Dykstra
- Department of Biomedical Engineering, University of Miami, Coral Gables, Florida 33143
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16
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Høybye MT, Andersen LM, Boelsbjerg HB. Making It Count - Tracing Signs of Consciousness and Potentiality in Severe Brain Injury in Denmark. Med Anthropol 2024; 43:115-129. [PMID: 38206318 DOI: 10.1080/01459740.2023.2300080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Healthcare professionals use various technologies to evaluate and support patients who have suffered severe brain injuries. They integrate monitoring and sensory assessments into their clinical practice, and these assessments can have an impact on treatment decisions and prognostication. Responses from patients during different interactions are interpreted as "signs of consciousness" when considered contextually relevant. This study is based on anthropological fieldwork conducted in specialized Danish intensive care units, where we explore how signs of consciousness are made to count through practices of enactment. We ethnographically trace how the clinical concept of potential influences the interpretation of signs of consciousness as a complex biosocial practice based on the biomedical assumption that consciousness is a vital indicator of what makes a life. The article provides insights into the potential for recovery as an emergent biosocial practice and contributes to a broader discussion within medical anthropology of the moral landscapes of clinical and experimental borderlands.
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Affiliation(s)
- Mette Terp Høybye
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Lise Marie Andersen
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Hanne Bess Boelsbjerg
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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17
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Dominik T, Mele A, Schurger A, Maoz U. Libet's legacy: A primer to the neuroscience of volition. Neurosci Biobehav Rev 2024; 157:105503. [PMID: 38072144 DOI: 10.1016/j.neubiorev.2023.105503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
The neuroscience of volition is an emerging subfield of the brain sciences, with hundreds of papers on the role of consciousness in action formation published each year. This makes the state-of-the-art in the discipline poorly accessible to newcomers and difficult to follow even for experts in the field. Here we provide a comprehensive summary of research in this field since its inception that will be useful to both groups. We also discuss important ideas that have received little coverage in the literature so far. We systematically reviewed a set of 2220 publications, with detailed consideration of almost 500 of the most relevant papers. We provide a thorough introduction to the seminal work of Benjamin Libet from the 1960s to 1980s. We also discuss common criticisms of Libet's method, including temporal introspection, the interpretation of the assumed physiological correlates of volition, and various conceptual issues. We conclude with recent advances and potential future directions in the field, highlighting modern methodological approaches to volition, as well as important recent findings.
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Affiliation(s)
| | - Alfred Mele
- Department of Philosophy, Florida State University, FL, USA
| | | | - Uri Maoz
- Brain Institute, Chapman University, CA, USA
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18
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Claassen J, Kondziella D, Alkhachroum A, Diringer M, Edlow BL, Fins JJ, Gosseries O, Hannawi Y, Rohaut B, Schnakers C, Stevens RD, Thibaut A, Monti M. Cognitive Motor Dissociation: Gap Analysis and Future Directions. Neurocrit Care 2024; 40:81-98. [PMID: 37349602 DOI: 10.1007/s12028-023-01769-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Patients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance. METHODS The Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs. RESULTS The group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain-computer interfaces. CONCLUSIONS To improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.
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Affiliation(s)
- Jan Claassen
- Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Michael Diringer
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph J Fins
- Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, NewYork Presbyterian Hospital, New York, NY, 10032, USA
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Yousef Hannawi
- Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Benjamin Rohaut
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP) - Pitié Salpêtrière, Paris, France
| | | | - Robert D Stevens
- Department of Anesthesiology and Critical Care Medicine, Neurology, and Radiology, School of Medicine, Secondary Appointment in Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Martin Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
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19
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Marino MH. Pharmacology in Treatment of Patients with Disorders of Consciousness. Phys Med Rehabil Clin N Am 2024; 35:155-165. [PMID: 37993186 DOI: 10.1016/j.pmr.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Pharmacologic treatment of disorders of consciousness remains a critical but challenging task for clinicians. Amantadine has been shown to promote the rate of neurologic recovery for patients with traumatic disorders of consciousness when administered between 4 and 16 weeks, as demonstrated by a well-designed randomized control trial. While there are no large, randomized controlled trials to support the use of other dopaminergic medicines (bromocriptine, levodopa, apomorphine), there is a large body of literature implicating their role in improving alertness and responsiveness in disorders of consciousness. Zolpidem can increase the level of consciousness in a small subset of patients. Zolpidem and intrathecal baclofen likely increase the level of consciousness via the mesocircuit pathway. Psychostimulant medications can be initiated in patients, even without strong evidence to support their use, as long as basic principles of brain injury medicine are followed, and there are systems in place to evaluate therapeutic response.
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Affiliation(s)
- Michael H Marino
- Moss Rehab, 60 Township Line Road, Elkins Park, PA 19027, USA; Remed Residential Brain Injury Center.
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20
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Tangonan R, Lazaridis C. Evaluation and Management of Disorders of Consciousness in the Acute Care Setting. Phys Med Rehabil Clin N Am 2024; 35:79-92. [PMID: 37993195 DOI: 10.1016/j.pmr.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Acute disorders of consciousness (DOC) are impairments in arousal and awareness that occur within 28 days of an initial injury and can result from a variety of insults. These states range from coma, unresponsive wakefulness, covert consciousness, minimal consciousness, to confusional state. It is important to perform thorough, serial examinations with particular emphasis on the level of consciousness, brainstem reflexes, and motor responses. Evaluation of acute DOC includes laboratory tests, imaging, and electrophysiology testing. Prognostication in the acute phase of DOC must be done cautiously, using open, frequent communication with families, and by acknowledging significant multidimensional uncertainty.
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Affiliation(s)
- Ruth Tangonan
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
| | - Christos Lazaridis
- Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
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21
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Triggiani AI, Lee SJ, Scheman K, Hallett M. Moving in response to an unseen visual stimulus. Clin Neurophysiol 2024; 158:92-102. [PMID: 38198875 PMCID: PMC10872446 DOI: 10.1016/j.clinph.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Whether consciousness has a causal role in voluntary movements is not clear. Backward masking blocks a stimulus from becoming conscious, but it can trigger movement in a reaction time paradigm. We hypothesize that if backward masking is used in a choice reaction time paradigm, when the visible stimulus (S2) differs from the masked stimulus (S1), the movement will often differ from conscious intent. We did such a study employing electroencephalography (EEG) to explore the brain activity associated with this effect. METHODS Twenty healthy adults participated in a choice reaction time task with a backwardly masked stimulus and EEG. They moved right or left hand in response to the direction of an arrow. S2 was congruent or incongruent with S1. When incongruent, responses were frequently concordant with S1, with faster reaction time than when responding to S2 and thought to be a mistake. RESULTS We show that it is possible to trigger movements from the unperceived stimuli indicating consciousness is not causal since the movement was not in accord with intent. EEG showed information flow from occipital cortex to motor cortex. CONCLUSIONS Occipital activity was the same despite response, but the parietal and frontal EEG differed. When responding to S1, the motor cortex responded as soon as information arrived, and when responding to S2, the motor cortex responded with a delay allowing for other brain processing prior to movement initiation. While the exact time of conscious recognition of S2 is not clear, when there is a response to S1, the frontal cortex signals an "error", but this is apparently too late to veto the movement. SIGNIFICANCE While consciousness does not initiate the movement, it monitors the concordance of intent and result.
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Affiliation(s)
- Antonio Ivano Triggiani
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Sae-Jin Lee
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kaya Scheman
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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22
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Cheng XR, Zhang YB, Sun DJ, Peng XY, Bao YC, Zhang F, Wang MX. Long-term repetitive transcranial direct current stimulation in patients with disorders of consciousness: a preliminary study. Brain Inj 2024; 38:68-75. [PMID: 38329075 DOI: 10.1080/02699052.2024.2304872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES To investigate the effects of long-term repetitive transcranial direct current stimulation on patients with DOC in the subacute phase. METHODS In a randomized, double-blind, controlled study, 33 patients were randomly assigned to the active or sham group, and 28 patients completed the study. Patients in the active group received anodal stimulation over the DLPFC, while patients in the sham group received placebo stimulation (20 min/day, 5 days/week, for 4 weeks). The level of consciousness among patients was assessed with the Coma Recovery Scale-Revised (CRS-R) at baseline and at the end of every week from the first to the fourth week. RESULTS The CRS-R scores of both the active and sham groups showed a consistent increasing trend over time; however, the treatment effect of the active group was better than that of the sham group. In addition, there was a statistically significant difference in the total CRS-R score between the two groups at weeks 1, 2, 3 and 4. Moreover, 10 patients (71.4%) in the active group and 3 patients (21.4%) in the sham group were regarded as responders. CONCLUSION Long-term tDCS could improve the level of consciousness of patients with DOC in the subacute stage.
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Affiliation(s)
- Xiao Rong Cheng
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Yi Bao Zhang
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Deng Juan Sun
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Xiao Yun Peng
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Ying Cun Bao
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Fang Zhang
- Department of Rehabilitation, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
| | - Man Xia Wang
- Department of Neurology, The Second Hospital of Lanzhou University, Lan Zhou, Gan Su Province, China
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23
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Riganello F, Vatrano M, Cortese MD, Tonin P, Soddu A. Central autonomic network and early prognosis in patients with disorders of consciousness. Sci Rep 2024; 14:1610. [PMID: 38238457 PMCID: PMC10796939 DOI: 10.1038/s41598-024-51457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
The central autonomic network (CAN) plays a crucial role in modulating the autonomic nervous system. Heart rate variability (HRV) is a valuable marker for assessing CAN function in disorders of consciousness (DOC) patients. We used HRV analysis for early prognosis in 58 DOC patients enrolled within ten days of hospitalization. They underwent a five-minute electrocardiogram during baseline and acoustic/visual stimulation. The coma recovery scale-revised (CRS-R) was used to define the patient's consciousness level and categorize the good/bad outcome at three months. The high-frequency Power Spectrum Density and the standard deviation of normal-to-normal peaks in baseline, the sample entropy during the stimulation, and the time from injury features were used in the support vector machine analysis (SVM) for outcome prediction. The SVM predicted the patients' outcome with an accuracy of 96% in the training test and 100% in the validation test, underscoring its potential to provide crucial clinical information about prognosis.
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Affiliation(s)
- Francesco Riganello
- Reseach in Advanced Neurorehabilitation, S. Anna Institute, 88900, Crotone, Italy.
| | - Martina Vatrano
- Reseach in Advanced Neurorehabilitation, S. Anna Institute, 88900, Crotone, Italy
| | | | - Paolo Tonin
- Reseach in Advanced Neurorehabilitation, S. Anna Institute, 88900, Crotone, Italy
| | - Andrea Soddu
- Physics & Astronomy Department and Western Institute for Neuroscience, University of Western Ontario, London, ON, Canada
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24
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Abstract
Covert consciousness is a state of residual awareness following severe brain injury or neurological disorder that evades routine bedside behavioral detection. Patients with covert consciousness have preserved awareness but are incapable of self-expression through ordinary means of behavior or communication. Growing recognition of the limitations of bedside neurobehavioral examination in reliably detecting consciousness, along with advances in neurotechnologies capable of detecting brain states or subtle signs indicative of consciousness not discernible by routine examination, carry promise to transform approaches to classifying, diagnosing, prognosticating and treating disorders of consciousness. Here we describe and critically evaluate the evolving clinical category of covert consciousness, including approaches to its diagnosis through neuroimaging, electrophysiology, and novel behavioral tools, its prognostic relevance, and open questions pertaining to optimal clinical management of patients with covert consciousness recovering from severe brain injury.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Yelena G Bodien
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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25
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Lenharo M. The consciousness wars: can scientists ever agree on how the mind works? Nature 2024; 625:438-440. [PMID: 38233623 DOI: 10.1038/d41586-024-00107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
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26
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Robbins NM, Bernat JL. Ethical issues of nosology in disorders of consciousness. NeuroRehabilitation 2024; 54:3-9. [PMID: 38277312 DOI: 10.3233/nre-230120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
The current classification scheme for severe disorders of consciousness (DoC) has several shortcomings. First, there is no consensus on how to incorporate patients with covert consciousness. Second, there is a mismatch between the definitions of severe DoC, based on consciousness, and the diagnosis of these same DoC, which is based on observable motoric responsiveness. Third, current categories are grouped into large heterogeneous syndromes which share phenotype, but do not incorporate underlying pathophysiology. Here we discuss several ethical issues pertaining to the current nosology of severe DoC. We conclude by proposing a revised nosology which addresses these shortcomings.
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Affiliation(s)
- Nathaniel M Robbins
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James L Bernat
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Zhu J, Chen C, Liu X, He M, Fang Y, Wang L, Jia J, Guo J, Zhao Z, Gao C, He J, Xu C, Xu F, Ma D, Wang J, Zhang Z. Cerebellar Purkinje cell firing promotes conscious recovery from anesthesia state through coordinating neuronal communications with motor cortex. Theranostics 2024; 14:480-495. [PMID: 38169536 PMCID: PMC10758059 DOI: 10.7150/thno.89592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/11/2023] [Indexed: 01/05/2024] Open
Abstract
Background: The neurobiological basis of gaining consciousness from unconscious state induced by anesthetics remains unknown. This study was designed to investigate the involvement of the cerebello-thalamus-motor cortical loop mediating consciousness transitions from the loss of consciousness (LOC) induced by an inhalational anesthetic sevoflurane in mice. Methods: The neural tracing and fMRI together with opto-chemogenetic manipulation were used to investigate the potential link among cerebello-thalamus-motor cortical brain regions. The fiber photometry of calcium and neurotransmitters, including glutamate (Glu), γ-aminobutyric acid (GABA) and norepinephrine (NE), were monitored from the motor cortex (M1) and the 5th lobule of the cerebellar vermis (5Cb) during unconsciousness induced by sevoflurane and gaining consciousness after sevoflurane exposure. Cerebellar Purkinje cells were optogenetically manipulated to investigate their influence on consciousness transitions during and after sevoflurane exposure. Results: Activation of 5Cb Purkinje cells increased the Ca2+ flux in the M1 CaMKIIα+ neurons, but this increment was significantly reduced by inactivation of posterior and parafascicular thalamic nucleus. The 5Cb and M1 exhibited concerted calcium flux, and glutamate and GABA release during transitions from wakefulness, loss of consciousness, burst suppression to conscious recovery. Ca2+ flux and Glu release in the M1, but not in the 5Cb, showed a strong synchronization with the EEG burst suppression, particularly, in the gamma-band range. In contrast, the Glu, GABA and NE release and Ca2+ oscillations were coherent with the EEG gamma band activity only in the 5Cb during the pre-recovery of consciousness period. The optogenetic activation of Purkinje cells during burst suppression significantly facilitated emergence from anesthesia while the optogenetic inhibition prolonged the time to gaining consciousness. Conclusions: Our data indicate that cerebellar neuronal communication integrated with motor cortex through thalamus promotes consciousness recovery from anesthesia which may likely serve as arousal regulation.
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Affiliation(s)
- Jinpiao Zhu
- Department of Anesthesiology, Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chang Chen
- Department of Anesthesiology, Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Xiaodong Liu
- Department of Anesthesia and Intensive Care, Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, P.R. China
| | - Mengying He
- Department of Anesthesiology, Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Yuanyuan Fang
- Department of Anesthesiology, Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Li Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan 430071, China
| | - Junke Jia
- Department of Anesthesiology, Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Juan Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziyue Zhao
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan 430071, China
| | - Chenyi Gao
- Department of Anesthesiology, Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Jingang He
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan 430071, China
| | - Chengshi Xu
- Department of Anesthesiology, Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Fuqiang Xu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan 430071, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Daqing Ma
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Division of Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan 430071, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zongze Zhang
- Department of Anesthesiology, Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
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Mansell W. An integrative control theory perspective on consciousness. Psychol Rev 2024; 131:1-17. [PMID: 35786987 DOI: 10.1037/rev0000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An integrative account of consciousness should have a number of properties. It should build upon a framework of nonconscious behavior in order to explain how and why consciousness contributes to, and addresses the limitations of, nonconscious processes. It should also encompass the primary (phenomenal), secondary (access), and tertiary (self-awareness) aspects of consciousness. A number of accounts have proposed a role for consciousness in the prediction of sensory input, yet these proposals do not address how organisms deal with multiple, unpredictable, disturbances to maintain control. According to perceptual control theory (PCT), purposiveness is the control of hierarchically organized perceptual variables via changes in output that counteract disturbances which would otherwise increase error between the current value and the reference value (goal state) of each perceptual variable. In PCT, reorganization is the process required for the adaptive modification of control systems in order to reduce the error in intrinsic systems that control essential, largely physiological, variables. The current article proposes that primary consciousness emerges from this system, and is sustained as secondary consciousness through a number of processes including the control of the integration rate of novel information via exploratory behavior, attention, imagination, and altering the mutation rate of reorganization. Tertiary consciousness arises when internally sustained perceptual information is associated with specific symbols that form a parallel, propositional system for the use of language, logic, and other symbolic systems. The hypotheses and initial research designs to test this account are provided. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Koay JM, Sabsevitz DS, Ritaccio A, Feyissa AM, Tatum W, Blackmon K. Is preserved consciousness during seizures associated with quality of life among patients with drug-resistant epilepsy? Epilepsy Behav 2024; 150:109585. [PMID: 38096662 DOI: 10.1016/j.yebeh.2023.109585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 01/14/2024]
Abstract
Drug-resistant epilepsy is associated with reduced quality of life (QoL) due to a myriad of disease-related and psychosocial factors. Although consciousness during seizures is a core feature of seizure classification, its impact on QoL in people with epilepsy (PWE) is not well understood. This study aimed to address this gap by comparing QoL between PWE with focal aware (FA) versus impaired awareness (FIA) seizures. Sixty-nine adults with epilepsy completed the Quality of Life in Epilepsy-31 (QoLIE-31) inventory as part of their pre-surgical neuropsychological evaluation (FA: n = 26, FIA: n = 43). There was no group difference in seizure burden as defined by the proportion of comorbid focal to bilateral tonic-clonic seizures (FA:65.4 %; FIA: 79.1 %). People with FA seizures reported lower overall QoL than people with FIA seizures; sub-scale analyses revealed that seizure worry drives this effect. There was no difference in QoL between people with motor and non-motor FA seizures. Results suggest that FA seizures are burdensome on the QoL of PWE. FA seizures may contribute to seizure worry due to preserved awareness of aversive peri-ictal phenomenon. Findings suggest that clinical efforts should continue to be made to optimize seizure control in people with breakthrough FA seizures. Prospective longitudinal monitoring of QoL in trials of consciousness-targeting neurostimulation therapy is needed to determine if QoL changes as a function of improved peri-ictal consciousness following treatment.
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Affiliation(s)
- Jun Min Koay
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA.
| | - David S Sabsevitz
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - William Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Karen Blackmon
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA; Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Slijepcevic P. Principles of cognitive biology and the concept of biocivilisations. Biosystems 2024; 235:105109. [PMID: 38157923 DOI: 10.1016/j.biosystems.2023.105109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/16/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Abstract
A range of studies published in the last few decades promotes the cognitive aspects of life: all organisms, from bacteria to mammals, are capable of sensing/perception, decision-making, problem-solving, learning, and other cognitive functions, including sentience and consciousness. In this paper I present a scientific and philosophical synthesis of these studies, leading to an integrated view of cognitive biology. This view is expressed through the four principles applicable to all living systems: (1) sentience and consciousness, (2) autopoiesis, (3) free energy principle and relational biology, and (4) cognitive repertoire. The principles are circular, and they reinforce themselves. The circularity is not rigid, meaning that hierarchical and heterarchical shifts are widespread in the biosphere. The above principles emerged at the dawn of life, with the first cells, bacteria and archaea. All biogenic forms and functions that emerged since then can be traced to the first cells - indivisible units of biological agency. Following these principles, I developed the concept of biocivilisations to explain various forms of social intelligence in different kingdoms of life. The term biociviloisations draws on the human interpretation of the concept of civilisation, which searches for non-human equivalents of communication, engineering, science, medicine, art, and agriculture, in all kingdoms of life by applying the principles of cognitive biology. Potential avenues for testing the concept of biocivilisations are highlighted.
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Affiliation(s)
- Predrag Slijepcevic
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UB8 3PH, England, UK.
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31
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Torday JS, Klein M, Maimon O. The mobius strip, the cell, and soft logic mathematics. Prog Biophys Mol Biol 2024; 186:65-70. [PMID: 38160943 DOI: 10.1016/j.pbiomolbio.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
The cell-cell signaling mechanisms that are the basis for all of physiology have been used to trace evolution back to the unicellular state, and beyond, to the "First Principles of Physiology". And since our physiology derives from the Cosmos based on Symbiogenesis, it has been hypothesized that the cell behaves like a functional Mobius Strip, having no 'inside or outside' cell membrane surface - it is continuous with the Cosmos, its history being codified from Quantum Entanglement to Newtonian Mechanics, affording the cell consciousness and unconsciousness/subconsciousness as a continuum for the first time. Similarly, Klein and Maimon have concluded that their 'Soft Logic' mathematics also constitutes a Mobius Strip, using both a real number axis, combined with a zero axis, numerically representing cognition. This is congruent with the cell as 'two-tiered' consciousness, the first tier being the real-time interface between the cell membrane and its environment; the second tier constituting integrated physiology, referencing the consciousness of the Cosmos. Thus, there is coherence between physiology, consciousness and mathematics for the first time.
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Affiliation(s)
- John S Torday
- University of California, Los Angeles, United States.
| | - Moshe Klein
- TAU Laboratory for Consciousness and Soft Logic Research, Tel- Aviv University and Tel Hai College, Israel.
| | - Oded Maimon
- TAU Laboratory for Consciousness and Soft Logic Research, Tel-Aviv University, Israel.
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32
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Shu Z, Wu J, Lu J, Li H, Liu J, Lin J, Liang S, Wu J, Han J, Yu N. Effective DBS treatment improves neural information transmission of patients with disorders of consciousness: an fNIRS study. Physiol Meas 2023; 44:125011. [PMID: 38086065 DOI: 10.1088/1361-6579/ad14ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023]
Abstract
Objective.Deep brain stimulation (DBS) is a potential treatment that promotes the recovery of patients with disorders of consciousness (DOC). This study quantified the changes in consciousness and the neuromodulation effect of DBS on patients with DOC.Approach.Eleven patients were recruited for this study which consists of three conditions: 'Pre' (two days before DBS surgery), 'Post-On' (one month after surgery with stimulation), and 'Post-Off' (one month after surgery without stimulation). Functional near-infrared spectroscopy (fNIRS) was recorded from the frontal lobe, parietal lobe, and occipital lobe of patients during the experiment of auditory stimuli paradigm, in parallel with the coma recovery scale-revised (CRS-R) assessment. The brain hemodynamic states were defined and state transition acceleration was taken to quantify the information transmission strength of the brain network. Linear regression analysis was conducted between the changes in regional and global indicators and the changes in the CRS-R index.Main results.Significant correlation was observed between the changes in the global transition acceleration indicator and the changes in the CRS-R index (slope = 55.910,p< 0.001,R2= 0.732). For the regional indicators, similar correlations were found between the changes in the frontal lobe and parietal lobe indicators and the changes in the CRS-R index (slope = 46.612,p< 0.01,R2= 0.694; slope = 47.491,p< 0.01,R2= 0.676).Significance.Our study suggests that fNIRS-based brain hemodynamics transition analysis can signify the neuromodulation effect of DBS treatment on patients with DOC, and the transition acceleration indicator is a promising brain functional marker for DOC.
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Affiliation(s)
- Zhilin Shu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, People's Republic of China
- Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, People's Republic of China
- Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518083, People's Republic of China
| | - Jingchao Wu
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, People's Republic of China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Jiewei Lu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, People's Republic of China
- Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, People's Republic of China
- Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518083, People's Republic of China
| | - Haitao Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, People's Republic of China
| | - Jinrui Liu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, People's Republic of China
- Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, People's Republic of China
- Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518083, People's Republic of China
| | - Jianeng Lin
- College of Artificial Intelligence, Nankai University, Tianjin 300350, People's Republic of China
- Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, People's Republic of China
- Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518083, People's Republic of China
| | - Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, People's Republic of China
| | - Jialing Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, People's Republic of China
- Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin 300350, People's Republic of China
| | - Jianda Han
- College of Artificial Intelligence, Nankai University, Tianjin 300350, People's Republic of China
- Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, People's Republic of China
- Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518083, People's Republic of China
| | - Ningbo Yu
- College of Artificial Intelligence, Nankai University, Tianjin 300350, People's Republic of China
- Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin 300350, People's Republic of China
- Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen 518083, People's Republic of China
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Peters A, Bruchmann M, Dellert T, Moeck R, Schlossmacher I, Straube T. Stimulus awareness is associated with secondary somatosensory cortex activation in an inattentional numbness paradigm. Sci Rep 2023; 13:22575. [PMID: 38114726 PMCID: PMC10730535 DOI: 10.1038/s41598-023-49857-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
While inattentional blindness and deafness studies have revealed neural correlates of consciousness (NCC) without the confound of task relevance in the visual and auditory modality, comparable studies for the somatosensory modality are lacking. Here, we investigated NCC using functional magnetic resonance imaging (fMRI) in an inattentional numbness paradigm. Participants (N = 44) received weak electrical stimulation on the left hand while solving a demanding visual task. Half of the participants were informed that task-irrelevant weak tactile stimuli above the detection threshold would be applied during the experiment, while the other half expected stimuli below the detection threshold. Unexpected awareness assessments after the experiment revealed that altogether 10 participants did not consciously perceive the somatosensory stimuli during the visual task. Awareness was not significantly modulated by prior information. The fMRI data show that awareness of stimuli led to increased activation in the contralateral secondary somatosensory cortex. We found no significant effects of stimulus awareness in the primary somatosensory cortex or frontoparietal areas. Thus, our results support the hypothesis that somatosensory stimulus awareness is mainly based on activation in higher areas of the somatosensory cortex and does not require strong activation in extended anterior or posterior networks, which is usually seen when perceived stimuli are task-relevant.
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Affiliation(s)
- Antje Peters
- Institute of Medical Psychology and Systems Neuroscience, University Hospital Münster, Von-Esmarch-Straße 52, 48149, Münster, Germany.
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, 48149, Münster, Germany.
| | - Maximilian Bruchmann
- Institute of Medical Psychology and Systems Neuroscience, University Hospital Münster, Von-Esmarch-Straße 52, 48149, Münster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, 48149, Münster, Germany
| | - Torge Dellert
- Institute of Medical Psychology and Systems Neuroscience, University Hospital Münster, Von-Esmarch-Straße 52, 48149, Münster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, 48149, Münster, Germany
| | - Robert Moeck
- Institute of Medical Psychology and Systems Neuroscience, University Hospital Münster, Von-Esmarch-Straße 52, 48149, Münster, Germany
| | - Insa Schlossmacher
- Institute of Medical Psychology and Systems Neuroscience, University Hospital Münster, Von-Esmarch-Straße 52, 48149, Münster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, 48149, Münster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University Hospital Münster, Von-Esmarch-Straße 52, 48149, Münster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, 48149, Münster, Germany
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Edlow BL, Boerwinkle VL, Annen J, Boly M, Gosseries O, Laureys S, Mukherjee P, Puybasset L, Stevens RD, Threlkeld ZD, Newcombe VFJ, Fernandez-Espejo D. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Neuroimaging. Neurocrit Care 2023; 39:611-617. [PMID: 37552410 DOI: 10.1007/s12028-023-01794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Over the past 5 decades, advances in neuroimaging have yielded insights into the pathophysiologic mechanisms that cause disorders of consciousness (DoC) in patients with severe brain injuries. Structural, functional, metabolic, and perfusion imaging studies have revealed specific neuroanatomic regions, such as the brainstem tegmentum, thalamus, posterior cingulate cortex, medial prefrontal cortex, and occipital cortex, where lesions correlate with the current or future state of consciousness. Advanced imaging modalities, such as diffusion tensor imaging, resting-state functional magnetic resonance imaging (fMRI), and task-based fMRI, have been used to improve the accuracy of diagnosis and long-term prognosis, culminating in the endorsement of fMRI for the clinical evaluation of patients with DoC in the 2018 US (task-based fMRI) and 2020 European (task-based and resting-state fMRI) guidelines. As diverse neuroimaging techniques are increasingly used for patients with DoC in research and clinical settings, the need for a standardized approach to reporting results is clear. The success of future multicenter collaborations and international trials fundamentally depends on the implementation of a shared nomenclature and infrastructure. METHODS To address this need, the Neurocritical Care Society's Curing Coma Campaign convened an international panel of DoC neuroimaging experts to propose common data elements (CDEs) for data collection and reporting in this field. RESULTS We report the recommendations of this CDE development panel and disseminate CDEs to be used in neuroimaging studies of patients with DoC. CONCLUSIONS These CDEs will support progress in the field of DoC neuroimaging and facilitate international collaboration.
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Affiliation(s)
- Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Varina L Boerwinkle
- Clinical Resting-State Functional Magnetic Resonance Imaging Laboratory and Service, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre de Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Melanie Boly
- Department of Neurology, University of Wisconsin, Madison, WI, USA
- Department of Psychiatry, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin, Madison, WI, USA
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre de Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre de Cerveau2, University Hospital of Liège, Liège, Belgium
- CERVO Research Institute, Laval University, Quebec, Canada
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Louis Puybasset
- Department of Anesthesiology and Intensive Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert D Stevens
- Departments of Anesthesiology and Critical Care Medicine, Neurology, Radiology, and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zachary D Threlkeld
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Davinia Fernandez-Espejo
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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35
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Wagner-Altendorf TA. Philosophy and neuroscience on consciousness - response to Felipe León and Dan Zahavi. Acta Neurochir (Wien) 2023; 165:3583-3584. [PMID: 37945997 PMCID: PMC10739454 DOI: 10.1007/s00701-023-05873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Tobias A Wagner-Altendorf
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Munich School of Philosophy, Munich, Germany.
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36
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Zhang Y, Wang Y, Cheng H, Yan F, Li D, Song D, Wang Q, Huang L. EEG spectral slope: A reliable indicator for continuous evaluation of consciousness levels during propofol anesthesia. Neuroimage 2023; 283:120426. [PMID: 37898378 DOI: 10.1016/j.neuroimage.2023.120426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023] Open
Abstract
The level of consciousness undergoes continuous alterations during anesthesia. Prior to the onset of propofol-induced complete unconsciousness, degraded levels of behavioral responsiveness can be observed. However, a reliable index to monitor altered consciousness levels during anesthesia has not been sufficiently investigated. In this study, we obtained 60-channel EEG data from 24 healthy participants during an ultra-slow propofol infusion protocol starting with an initial concentration of 1 μg/ml and a stepwise increase of 0.2 μg/ml in concentration. Consecutive auditory stimuli were delivered every 5 to 6 s, and the response time to the stimuli was used to assess the responsiveness levels. We calculated the spectral slope in a time-resolved manner by extracting 5-second EEG segments at each auditory stimulus and estimated their correlation with the corresponding response time. Our results demonstrated that during slow propofol infusion, the response time to external stimuli increased, while the EEG spectral slope, fitted at 15-45 Hz, became steeper, and a significant negative correlation was observed between them. Moreover, the spectral slope further steepened at deeper anesthetic levels and became flatter during anesthesia recovery. We verified these findings using an external dataset. Additionally, we found that the spectral slope of frontal electrodes over the prefrontal lobe had the best performance in predicting the response time. Overall, this study used a time-resolved analysis to suggest that the EEG spectral slope could reliably track continuously altered consciousness levels during propofol anesthesia. Furthermore, the frontal spectral slope may be a promising index for clinical monitoring of anesthesia depth.
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Affiliation(s)
- Yun Zhang
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Yubo Wang
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Huanhuan Cheng
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Fei Yan
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Dingning Li
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China
| | - Dawei Song
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China
| | - Qiang Wang
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an 710061, China.
| | - Liyu Huang
- School of Life Science and Technology, Xidian University, No.2 TaiBai South Road, Xi'an 710061, China.
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Gobert F, Corneyllie A, Bastuji H, Berthomier C, Thevenet M, Abernot J, Raverot V, Dailler F, Guérin C, Gronfier C, Luauté J, Perrin F. Twenty-four-hour rhythmicities in disorders of consciousness are associated with a favourable outcome. Commun Biol 2023; 6:1213. [PMID: 38030756 PMCID: PMC10687012 DOI: 10.1038/s42003-023-05588-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
Fluctuations of consciousness and their rhythmicities have been rarely studied in patients with a disorder of consciousness after acute brain injuries. 24-h assessment of brain (EEG), behaviour (eye-opening), and circadian (clock-controlled hormones secretion from urine) functions was performed in acute brain-injured patients. The distribution, long-term predictability, and rhythmicity (circadian/ultradian) of various EEG features were compared with the initial clinical status, the functional outcome, and the circadian rhythmicities of behaviour and clock-controlled hormones. Here we show that more physiological and favourable patterns of fluctuations are associated with a higher 24 h predictability and sharp up-and-down shape of EEG switches, reminiscent of the Flip-Flop model of sleep. Multimodal rhythmic analysis shows that patients with simultaneous circadian rhythmicity for brain, behaviour, and hormones had a favourable outcome. Finally, both re-emerging EEG fluctuations and homogeneous 24-h cycles for EEG, eye-opening, and hormones appeared as surrogates for preserved functionality in brainstem and basal forebrain, which are key prognostic factors for later improvement. While the recovery of consciousness has previously been related to a high short-term complexity, we suggest in this exploratory study the importance of the high predictability of the 24 h long-term generation of brain rhythms and highlight the importance of circadian body-brain rhythms in awakening.
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Affiliation(s)
- Florent Gobert
- Neuro-Intensive care unit, Hospices Civils de Lyon, Neurological hospital Pierre-Wertheimer, 59 Boulevard Pinel, Bron, France.
- Trajectoires Team, Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), Bâtiment Inserm 16 avenue Doyen Lépine, Bron, France.
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), 95 boulevard Pinel, Bron, France.
| | - Alexandra Corneyllie
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), 95 boulevard Pinel, Bron, France
| | - Hélène Bastuji
- Sleep medicine centre, Hospices Civils de Lyon, Bron, F-69677, France
- Neuropain Team, Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), 59 Boulevard Pinel, Bron, France
| | | | - Marc Thevenet
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), 95 boulevard Pinel, Bron, France
| | - Jonas Abernot
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), 95 boulevard Pinel, Bron, France
| | - Véronique Raverot
- Hormone Laboratory, Hospices Civils de Lyon, Neurological hospital Pierre-Wertheimer, 59 Boulevard Pinel, Bron, France
| | - Frédéric Dailler
- Neuro-Intensive care unit, Hospices Civils de Lyon, Neurological hospital Pierre-Wertheimer, 59 Boulevard Pinel, Bron, France
| | - Claude Guérin
- Intensive care unit, Hospices Civils de Lyon, Croix-Rousse hospital, 103 Grande-Rue de la Croix-Rousse, Lyon, France
- Intensive care unit, Hospices Civils de Lyon, Édouard Herriot hospital, 5 Place d'Arsonval, 69003, Lyon, France
| | - Claude Gronfier
- Waking team (Integrative Physiology of the Brain Arousal Systems), Lyon Neuroscience Research Centre, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Jacques Luauté
- Trajectoires Team, Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), Bâtiment Inserm 16 avenue Doyen Lépine, Bron, France
- Neuro-rehabilitation unit, Hospices Civils de Lyon, Neurological hospital Pierre-Wertheimer, 59 Boulevard Pinel, Bron, France
| | - Fabien Perrin
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), 95 boulevard Pinel, Bron, France
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Sangare A, Quirins M, Marois C, Valente M, Weiss N, Perez P, Ben Salah A, Munoz-Musat E, Demeret S, Rohaut B, Sitt JD, Eymond C, Naccache L. Pupil dilation response elicited by violations of auditory regularities is a promising but challenging approach to probe consciousness at the bedside. Sci Rep 2023; 13:20331. [PMID: 37989756 PMCID: PMC10663629 DOI: 10.1038/s41598-023-47806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/18/2023] [Indexed: 11/23/2023] Open
Abstract
Pupil dilation response (PDR) has been proposed as a physiological marker of conscious access to a stimulus or its attributes, such as novelty. In a previous study on healthy volunteers, we adapted the auditory "local global" paradigm and showed that violations of global regularity elicited a PDR. Notably without instructions, this global effect was present only in participants who could consciously report violations of global regularities. In the present study, we used a similar approach in 24 non-communicating patients affected with a Disorder of Consciousness (DoC) and compared PDR to ERPs regarding diagnostic and prognostic performance. At the group level, global effect could not be detected in DoC patients. At the individual level, the only patient with a PDR global effect was in a MCS and recovered consciousness at 6 months. Contrasting the most regular trials to the most irregular ones improved PDR's diagnostic and prognostic power in DoC patients. Pupillometry is a promising tool but requires several methodological improvements to enhance the signal-to-noise ratio and make it more robust for probing consciousness and cognition in DoC patients.
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Affiliation(s)
- Aude Sangare
- Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Charles Foix, Département de Neurophysiologie, Sorbonne Université, Paris, France.
- INSERM U 1127, PICNIC, Lab, Institut du Cerveau et de la Moelle Épinière, ICM, 75013, Paris, France.
| | - Marion Quirins
- Département de Neurologie, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Clémence Marois
- AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive et Réanimation à Orientation Neurologique & Groupe de Recherche Clinique en REanimation et Soins Intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, Sorbonne Université, Paris, France
| | - Mélanie Valente
- Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Charles Foix, Département de Neurophysiologie, Sorbonne Université, Paris, France
- INSERM U 1127, PICNIC, Lab, Institut du Cerveau et de la Moelle Épinière, ICM, 75013, Paris, France
| | - Nicolas Weiss
- AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive et Réanimation à Orientation Neurologique & Groupe de Recherche Clinique en REanimation et Soins Intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, Sorbonne Université, Paris, France
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de Recherche Saint-Antoine (CRSA), Maladies Métaboliques, Biliaires et Fibro-Inflammatoire du Foie & Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Pauline Perez
- Anesthesia and Intensive Care Unit, Lyon Medical Intensive Care Unit, Edouard, Herriot Hospital, Hospices Civils de Lyon, 69437, Lyon, France
| | - Amina Ben Salah
- Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Charles Foix, Département de Neurophysiologie, Sorbonne Université, Paris, France
- INSERM U 1127, PICNIC, Lab, Institut du Cerveau et de la Moelle Épinière, ICM, 75013, Paris, France
| | - Esteban Munoz-Musat
- INSERM U 1127, PICNIC, Lab, Institut du Cerveau et de la Moelle Épinière, ICM, 75013, Paris, France
| | - Sophie Demeret
- AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive et Réanimation à Orientation Neurologique & Groupe de Recherche Clinique en REanimation et Soins Intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université, Sorbonne Université, Paris, France
| | - Benjamin Rohaut
- Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Charles Foix, Département de Neurophysiologie, Sorbonne Université, Paris, France
- INSERM U 1127, PICNIC, Lab, Institut du Cerveau et de la Moelle Épinière, ICM, 75013, Paris, France
| | - Jacobo D Sitt
- INSERM U 1127, PICNIC, Lab, Institut du Cerveau et de la Moelle Épinière, ICM, 75013, Paris, France
| | - Cecile Eymond
- INSERM U 1127, PICNIC, Lab, Institut du Cerveau et de la Moelle Épinière, ICM, 75013, Paris, France
| | - Lionel Naccache
- Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Charles Foix, Département de Neurophysiologie, Sorbonne Université, Paris, France.
- INSERM U 1127, PICNIC, Lab, Institut du Cerveau et de la Moelle Épinière, ICM, 75013, Paris, France.
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Klar P, Çatal Y, Fogel S, Jocham G, Langner R, Owen AM, Northoff G. Auditory inputs modulate intrinsic neuronal timescales during sleep. Commun Biol 2023; 6:1180. [PMID: 37985812 PMCID: PMC10661171 DOI: 10.1038/s42003-023-05566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
Functional magnetic resonance imaging (fMRI) studies have demonstrated that intrinsic neuronal timescales (INT) undergo modulation by external stimulation during consciousness. It remains unclear if INT keep the ability for significant stimulus-induced modulation during primary unconscious states, such as sleep. This fMRI analysis addresses this question via a dataset that comprises an awake resting-state plus rest and stimulus states during sleep. We analyzed INT measured via temporal autocorrelation supported by median frequency (MF) in the frequency-domain. Our results were replicated using a biophysical model. There were two main findings: (1) INT prolonged while MF decreased from the awake resting-state to the N2 resting-state, and (2) INT shortened while MF increased during the auditory stimulus in sleep. The biophysical model supported these results by demonstrating prolonged INT in slowed neuronal populations that simulate the sleep resting-state compared to an awake state. Conversely, under sine wave input simulating the stimulus state during sleep, the model's regions yielded shortened INT that returned to the awake resting-state level. Our results highlight that INT preserve reactivity to stimuli in states of unconsciousness like sleep, enhancing our understanding of unconscious brain dynamics and their reactivity to stimuli.
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Affiliation(s)
- Philipp Klar
- Faculty of Mathematics and Natural Sciences, Institute of Experimental Psychology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany.
| | - Yasir Çatal
- The Royal's Institute of Mental Health Research & University of Ottawa, Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Room 6435, Ottawa, ON, K1Z 7K4, Canada
| | - Stuart Fogel
- Sleep Unit, University of Ottawa Institute of Mental Health Research at The Royal, K1Z 7K4, Ottawa, ON, Canada
| | - Gerhard Jocham
- Faculty of Mathematics and Natural Sciences, Institute of Experimental Psychology, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Robert Langner
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Adrian M Owen
- Departments of Physiology and Pharmacology and Psychology, Western University, London, ON, N6A 5B7, Canada
| | - Georg Northoff
- The Royal's Institute of Mental Health Research & University of Ottawa, Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Room 6435, Ottawa, ON, K1Z 7K4, Canada
- Centre for Cognition and Brain Disorders, Hangzhou Normal University, Tianmu Road 305, Hangzhou, Zhejiang Province, 310013, China
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Morais PLAG, Rubio-Garrido P, de Lima RM, Córdoba-Claros A, de Nascimento ES, Cavalcante JS, Clascá F. The Arousal-Related "Central Thalamus" Stimulation Site Simultaneously Innervates Multiple High-Level Frontal and Parietal Areas. J Neurosci 2023; 43:7812-7821. [PMID: 37758474 PMCID: PMC10648518 DOI: 10.1523/jneurosci.1216-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023] Open
Abstract
In human and nonhuman primates, deep brain stimulation applied at or near the internal medullary lamina of the thalamus [a region referred to as "central thalamus," (CT)], but not at nearby thalamic sites, elicits major changes in the level of consciousness, even in some minimally conscious brain-damaged patients. The mechanisms behind these effects remain mysterious, as the connections of CT had not been specifically mapped in primates. In marmoset monkeys (Callithrix jacchus) of both sexes, we labeled the axons originating from each of the various CT neuronal populations and analyzed their arborization patterns in the cerebral cortex and striatum. We report that, together, these CT populations innervate an array of high-level frontal, posterior parietal, and cingulate cortical areas. Some populations simultaneously target the frontal, parietal, and cingulate cortices, while others predominantly target the dorsal striatum. Our data indicate that CT stimulation can simultaneously engage a heterogeneous set of projection systems that, together, target the key nodes of the attention, executive control, and working-memory networks of the brain. Increased functional connectivity in these networks has been previously described as a signature of consciousness.SIGNIFICANCE STATEMENT In human and nonhuman primates, deep brain stimulation at a specific site near the internal medullary lamina of the thalamus ["central thalamus," (CT)] had been shown to restore arousal and awareness in anesthetized animals, as well as in some brain-damaged patients. The mechanisms behind these effects remain mysterious, as CT connections remain poorly defined in primates. In marmoset monkeys, we mapped with sensitive axon-labeling methods the pathways originated from CT. Our data indicate that stimulation applied in CT can simultaneously engage a heterogeneous set of projection systems that, together, target several key nodes of the attention, executive control, and working-memory networks of the brain. Increased functional connectivity in these networks has been previously described as a signature of consciousness.
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Affiliation(s)
- Paulo L A G Morais
- Federal University of Rio Grande do Norte, RN CEP 59078-900, Natal, Brazil
- Universidad Autónoma de Madrid, 28029 Madrid, Spain
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Overbeek BUH, van Erp WS, Eilander HJ, Koopmans RTCM, Lavrijsen JCM. Prevalence of the Minimally Conscious State Among Institutionalized Patients in the Netherlands: A Nationwide Study. Neurology 2023; 101:e2005-e2013. [PMID: 37857492 PMCID: PMC10662977 DOI: 10.1212/wnl.0000000000207820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/03/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The minimally conscious state (MCS) is a prolonged disorder of consciousness (pDoC) and one of the most severe outcomes of acquired brain injury. Prevalence data are scarce. The aim of this study was to establish the nationwide point prevalence of institutionalized patients in MCS in the Netherlands. METHODS This was a descriptive cross-sectional study in which all 86 Dutch hospitals, all 5 specialized pDoC rehabilitation facilities, and all 274 nursing homes were asked whether they were treating patients with a pDoC on the point prevalence date of September 15, 2021. Each patient's legal representative provided informed consent for their inclusion. Patient level of consciousness was verified using the Coma Recovery Scale-Revised (CRS-R) in a single assessment session performed in the facility of residence by an experienced physician. Data on patient demographics, etiology, level of consciousness, facility of residence, and clinical status were collected from a questionnaire by the treating physician. The prevalence of institutionalized patients in MCS of per 100,000 members of the Dutch population was calculated, based on actual census data. RESULTS Seventy patients were reported to have a pDoC, of whom 6 were excluded. The level of consciousness was verified for 49 patients while for 15, it could not be verified. Of the patients verified, 38 had a pDoC, of whom 32 were in MCS (mean age 44.8 years, 68.8% male). The prevalence of institutionalized patients in MCS is 0.2-0.3 per 100,000 Dutch inhabitants. Traumatic brain injury was present in 21 of 32 patients (65.6%). Specialized pDoC rehabilitation was received by 17 of 32 patients (53%), with the rest admitted to nursing homes. The most frequent signs of consciousness on the CRS-R were visual pursuit, reproducible movement to command, and automatic motor response. DISCUSSION This nationwide study revealed a low prevalence of institutionalized patients in MCS in the Netherlands. These findings are now being used to organize pDoC care in this country.
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Affiliation(s)
- Berno U H Overbeek
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands.
| | - Willemijn S van Erp
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
| | - Henk J Eilander
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
| | - Jan C M Lavrijsen
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
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Chudy D, Deletis V, Paradžik V, Dubroja I, Marčinković P, Orešković D, Chudy H, Raguž M. Deep brain stimulation in disorders of consciousness: 10 years of a single center experience. Sci Rep 2023; 13:19491. [PMID: 37945710 PMCID: PMC10636144 DOI: 10.1038/s41598-023-46300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
Disorders of consciousness (DoC), namely unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), represent severe conditions with significant consequences for patients and their families. Several studies have reported the regaining of consciousness in such patients using deep brain stimulation (DBS) of subcortical structures or brainstem nuclei. Our study aims to present the 10 years' experience of a single center using DBS as a therapy on a cohort of patients with DoC. Eighty Three consecutive patients were evaluated between 2011 and 2022; entry criteria consisted of neurophysiological and neurological evaluations and neuroimaging examinations. Out of 83, 36 patients were considered candidates for DBS implantation, and 32 patients were implanted: 27 patients had UWS, and five had MCS. The stimulation target was the centromedian-parafascicular complex in the left hemisphere in hypoxic brain lesion or the one better preserved in patients with traumatic brain injury. The level of consciousness was improved in seven patients. Three out of five MCS patients emerged to full awareness, with the ability to interact and communicate. Two of them can live largely independently. Four out of 27 UWS patients showed consciousness improvement with two patients emerging to full awareness, and the other two reaching MCS. In patients with DoC lasting longer than 12 months following traumatic brain injury or 6 months following anoxic-ischemic brain lesion, spontaneous recovery is rare. Thus, DBS of certain thalamic nuclei could be recommended as a treatment option for patients who meet neurological, neurophysiological and neuroimaging criteria, especially in earlier phases, before occurrence of irreversible musculoskeletal changes. Furthermore, we emphasize the importance of cooperation between centers worldwide in studies on the potentials of DBS in treating patients with DoC.
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Affiliation(s)
- Darko Chudy
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia.
- Department of Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Vedran Deletis
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- Albert Einstein College of Medicine, New York, USA
| | - Veronika Paradžik
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Ivan Dubroja
- Brain Trauma Unit, Specialty Hospital for Medical Rehabilitation, Krapinske Toplice, Croatia
| | - Petar Marčinković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Darko Orešković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Hana Chudy
- Department of Neurology, Dubrava University Hospital, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
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Watanabe R, Moriguchi Y. Young children's subjective and objective thresholds and emergent processes of visual consciousness using a backward masking task. Conscious Cogn 2023; 116:103605. [PMID: 37976780 DOI: 10.1016/j.concog.2023.103605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
Visual consciousness studies in humans have primarily focused on adults. However, whether young children's visual consciousness is similar to or different from that of adults remains unknown. This study examined young children's and adults' subjective awareness and objective discrimination for thresholds and emergent processes of visual consciousness in two experiments. In Experiment 1, 20 5-6-year-olds and 20 adults attempted a figure discrimination task using a square or a diamond as the target stimulus and responded, using a two-point scale, to a question on subjective awareness of the target stimulus with stimulus onset asynchronies (SOA) from 20 to 260 ms. In Experiment 2, 31 5-6-year-olds and 16 adults attempted the task and responded, using a four-point scale, to a question on subjective awareness with SOA from 50 to 550 ms. We measured the discrimination accuracy and the awareness scale with SOA and fit them to the sigmoid function. The results showed that the objective accuracy threshold of young children was larger than that of adults. Moreover, young children's subjective awareness threshold was larger than that of adults in the four-point but not in the two-point scale responses. Finally, there were no age differences in the emergent process of consciousness. This study suggests that the emergent process of consciousness in young children is similar to that in adults, however, the threshold in young children is larger than that in adults.
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Affiliation(s)
- Ryoichi Watanabe
- Graduation School of Letters, Kyoto University, Kyoto, Japan; Japan Society for the Promotion of Science, Japan.
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Zelmann R, Paulk AC, Tian F, Balanza Villegas GA, Dezha Peralta J, Crocker B, Cosgrove GR, Richardson RM, Williams ZM, Dougherty DD, Purdon PL, Cash SS. Differential cortical network engagement during states of un/consciousness in humans. Neuron 2023; 111:3479-3495.e6. [PMID: 37659409 PMCID: PMC10843836 DOI: 10.1016/j.neuron.2023.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 09/04/2023]
Abstract
What happens in the human brain when we are unconscious? Despite substantial work, we are still unsure which brain regions are involved and how they are impacted when consciousness is disrupted. Using intracranial recordings and direct electrical stimulation, we mapped global, network, and regional involvement during wake vs. arousable unconsciousness (sleep) vs. non-arousable unconsciousness (propofol-induced general anesthesia). Information integration and complex processing we`re reduced, while variability increased in any type of unconscious state. These changes were more pronounced during anesthesia than sleep and involved different cortical engagement. During sleep, changes were mostly uniformly distributed across the brain, whereas during anesthesia, the prefrontal cortex was the most disrupted, suggesting that the lack of arousability during anesthesia results not from just altered overall physiology but from a disconnection between the prefrontal and other brain areas. These findings provide direct evidence for different neural dynamics during loss of consciousness compared with loss of arousability.
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Affiliation(s)
- Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA.
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA
| | - Fangyun Tian
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Britni Crocker
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard-MIT Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ziv M Williams
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick L Purdon
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA
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45
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Rabus A, Curic D, Ivan VE, Esteves IM, Gruber AJ, Davidsen J. Changes in functional connectivity preserve scale-free neuronal and behavioral dynamics. Phys Rev E 2023; 108:L052301. [PMID: 38115411 DOI: 10.1103/physreve.108.l052301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/06/2023] [Indexed: 12/21/2023]
Abstract
Does the brain optimize itself for storage and transmission of information, and if so, how? The critical brain hypothesis is based in statistical physics and posits that the brain self-tunes its dynamics to a critical point or regime to maximize the repertoire of neuronal responses. Yet, the robustness of this regime, especially with respect to changes in the functional connectivity, remains an unsolved fundamental challenge. Here, we show that both scale-free neuronal dynamics and self-similar features of behavioral dynamics persist following significant changes in functional connectivity. Specifically, we find that the psychedelic compound ibogaine that is associated with an altered state of consciousness fundamentally alters the functional connectivity in the retrosplenial cortex of mice. Yet, the scale-free statistics of movement and of neuronal avalanches among behaviorally related neurons remain largely unaltered. This indicates that the propagation of information within biological neural networks is robust to changes in functional organization of subpopulations of neurons, opening up a new perspective on how the adaptive nature of functional networks may lead to optimality of information transmission in the brain.
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Affiliation(s)
- Anja Rabus
- Complexity Science Group, Department of Physics and Astronomy University of Calgary, Calgary, Alberta, Canada T2N 1N4
| | - Davor Curic
- Complexity Science Group, Department of Physics and Astronomy University of Calgary, Calgary, Alberta, Canada T2N 1N4
| | - Victorita E Ivan
- Canadian Centre for Behavioral Neuroscience University of Lethbridge, Lethbridge, Alberta, Canada T1K 3M4
| | - Ingrid M Esteves
- Canadian Centre for Behavioral Neuroscience University of Lethbridge, Lethbridge, Alberta, Canada T1K 3M4
| | - Aaron J Gruber
- Canadian Centre for Behavioral Neuroscience University of Lethbridge, Lethbridge, Alberta, Canada T1K 3M4
| | - Jörn Davidsen
- Complexity Science Group, Department of Physics and Astronomy University of Calgary, Calgary, Alberta, Canada T2N 1N4
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada T2N 4N1
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46
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Candia-Rivera D, Raimondo F, Pérez P, Naccache L, Tallon-Baudry C, Sitt JD. Conscious processing of global and local auditory irregularities causes differentiated heartbeat-evoked responses. eLife 2023; 12:e75352. [PMID: 37888955 PMCID: PMC10651171 DOI: 10.7554/elife.75352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 10/24/2023] [Indexed: 10/28/2023] Open
Abstract
Recent research suggests that brain-heart interactions are associated with perceptual and self-consciousness. In this line, the neural responses to visceral inputs have been hypothesized to play a leading role in shaping our subjective experience. This study aims to investigate whether the contextual processing of auditory irregularities modulates both direct neuronal responses to the auditory stimuli (ERPs) and the neural responses to heartbeats, as measured with heartbeat-evoked responses (HERs). HERs were computed in patients with disorders of consciousness, diagnosed with a minimally conscious state or unresponsive wakefulness syndrome. We tested whether HERs reflect conscious auditory perception, which can potentially provide additional information for the consciousness diagnosis. EEG recordings were taken during the local-global paradigm, which evaluates the capacity of a patient to detect the appearance of auditory irregularities at local (short-term) and global (long-term) levels. The results show that local and global effects produce distinct ERPs and HERs, which can help distinguish between the minimally conscious state and unresponsive wakefulness syndrome patients. Furthermore, we found that ERP and HER responses were not correlated suggesting that independent neuronal mechanisms are behind them. These findings suggest that HER modulations in response to auditory irregularities, especially local irregularities, may be used as a novel neural marker of consciousness and may aid in the bedside diagnosis of disorders of consciousness with a more cost-effective option than neuroimaging methods.
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Affiliation(s)
- Diego Candia-Rivera
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d’Etudes Cognitives, École Normale Supérieure, INSERM, Université PSLParisFrance
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
| | - Federico Raimondo
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Forschungszentrum JülichJülichGermany
- Institute of Systems Neuroscience, Heinrich Heine University DüsseldorfDüsseldorfGermany
| | - Pauline Pérez
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
- AP-HP, Hôpital de la Pitié Salpêtrière, Neuro ICU, DMU NeurosciencesParisFrance
| | - Lionel Naccache
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
- Pitié-Salpêtrière Faculty of Medicine, Pierre and Marie Curie University, Sorbonne UniversitiesParisFrance
- INSERM, National Institute of Health and Medical ResearchParisFrance
- Department of Neurology, Pitié-Salpêtrière Hospital Group, Public Hospital Network of ParisParisFrance
- Department of Neurophysiology, Pitié-Salpêtrière Hospital Group, Public Hospital Network of ParisParisFrance
| | - Catherine Tallon-Baudry
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d’Etudes Cognitives, École Normale Supérieure, INSERM, Université PSLParisFrance
| | - Jacobo D Sitt
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
- INSERM, National Institute of Health and Medical ResearchParisFrance
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Munn BR, Müller EJ, Medel V, Naismith SL, Lizier JT, Sanders RD, Shine JM. Neuronal connected burst cascades bridge macroscale adaptive signatures across arousal states. Nat Commun 2023; 14:6846. [PMID: 37891167 PMCID: PMC10611774 DOI: 10.1038/s41467-023-42465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The human brain displays a rich repertoire of states that emerge from the microscopic interactions of cortical and subcortical neurons. Difficulties inherent within large-scale simultaneous neuronal recording limit our ability to link biophysical processes at the microscale to emergent macroscopic brain states. Here we introduce a microscale biophysical network model of layer-5 pyramidal neurons that display graded coarse-sampled dynamics matching those observed in macroscale electrophysiological recordings from macaques and humans. We invert our model to identify the neuronal spike and burst dynamics that differentiate unconscious, dreaming, and awake arousal states and provide insights into their functional signatures. We further show that neuromodulatory arousal can mediate different modes of neuronal dynamics around a low-dimensional energy landscape, which in turn changes the response of the model to external stimuli. Our results highlight the promise of multiscale modelling to bridge theories of consciousness across spatiotemporal scales.
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Affiliation(s)
- Brandon R Munn
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
- Complex Systems, School of Physics, University of Sydney, Sydney, NSW, Australia.
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia.
| | - Eli J Müller
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Complex Systems, School of Physics, University of Sydney, Sydney, NSW, Australia
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia
| | - Vicente Medel
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
| | - Sharon L Naismith
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, Faculty of Science & Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Joseph T Lizier
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia
- School of Computer Science, The University of Sydney, Sydney, NSW, Australia
| | - Robert D Sanders
- Department of Anaesthetics & Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
- Central Clinical School & NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - James M Shine
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Complex Systems, School of Physics, University of Sydney, Sydney, NSW, Australia
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia
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Grégoire L, Robinson TD, Choi JM, Greening SG. Conscious expectancy rather than associative strength elicits brain activity during single-cue fear conditioning. Soc Cogn Affect Neurosci 2023; 18:nsad054. [PMID: 37756616 PMCID: PMC10597625 DOI: 10.1093/scan/nsad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/14/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023] Open
Abstract
The neurocognitive processes underlying Pavlovian conditioning in humans are still largely debated. The conventional view is that conditioned responses (CRs) emerge automatically as a function of the contingencies between a conditioned stimulus (CS) and an unconditioned stimulus (US). As such, the associative strength model asserts that the frequency or amplitude of CRs reflects the strength of the CS-US associations. Alternatively, the expectation model asserts that the presentation of the CS triggers conscious expectancy of the US, which is responsible for the production of CRs. The present study tested the hypothesis that there are dissociable brain networks related to the expectancy and associative strength theories using a single-cue fear conditioning paradigm with a pseudo-random intermittent reinforcement schedule during functional magnetic resonance imaging. Participants' (n = 21) trial-by-trial expectations of receiving shock displayed a significant linear effect consistent with the expectation model. We also found a positive linear relationship between the expectancy model and activity in frontoparietal brain areas including the dorsolateral prefrontal cortex (PFC) and dorsomedial PFC. While an exploratory analysis found a linear relationship consistent with the associated strength model in the insula and early visual cortex, our primary results are consistent with the view that conscious expectancy contributes to CRs.
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Affiliation(s)
- Laurent Grégoire
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
- Department of Psychology and Brain Sciences, Texas A&M, College Station, TX 77843-4235, USA
| | - Tyler D Robinson
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Jong Moon Choi
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
- Statistical Methodology Division, Statistics Research Institute, Daejeon 35208, South Korea
| | - Steven G Greening
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
- Department of Psychology, University of Manitoba, Winnipeg R3T 2N2, Canada
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49
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Boulakis PA, Mortaheb S, van Calster L, Majerus S, Demertzi A. Whole-Brain Deactivations Precede Uninduced Mind-Blanking Reports. J Neurosci 2023; 43:6807-6815. [PMID: 37643862 PMCID: PMC10552942 DOI: 10.1523/jneurosci.0696-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/11/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
Mind-blanking (MB) is termed as the inability to report our immediate-past mental content. In contrast to mental states with reportable content, such as mind-wandering or sensory perceptions, the neural correlates of MB started getting elucidated only recently. A notable particularity that pertains to MB studies is the way MB is instructed for reporting, like by deliberately asking participants to "empty their minds." Such instructions were shown to induce fMRI activations in frontal brain regions, typically associated with metacognition and self-evaluative processes, suggesting that MB may be a result of intentional mental content suppression. Here, we aim at examining this hypothesis by determining the neural correlates of MB without induction. Using fMRI combined with experience-sampling in 31 participants (22 female), univariate analysis of MB reports revealed deactivations in occipital, frontal, parietal, and thalamic areas, but no activations in prefrontal regions. These findings were confirmed using Bayesian region-of-interest analysis on areas previously shown to be implicated in induced MB, where we report evidence for frontal deactivations during MB reports compared with other mental states. Contrast analysis between reports of MB and content-oriented mental states also revealed deactivations in the left angular gyrus. We propose that these effects characterize a neuronal profile of MB, where key thalamocortical nodes are unable to communicate and formulate reportable content. Collectively, we show that study instructions for MB lead to differential neural activation. These results provide mechanistic insights linked to the phenomenology of MB and point to the possibility of MB being expressed in different forms.SIGNIFICANCE STATEMENT This study explores how brain activity changes when individuals report unidentifiable thoughts, a phenomenon known as mind-blanking (MB). It aims to detect changes in brain activations and deactivations when MB is reported spontaneously, as opposed to the neural responses that have been previously reported when MB is induced. By means of brain imaging and experience-sampling, the study points to reduced brain activity in a wide number of regions, including those mesio-frontally which were previously detected as activated during induced MB. These results enhance our understanding of the complexity of spontaneous thinking and contribute to broader discussions on consciousness and reportable experience.
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Affiliation(s)
- Paradeisios Alexandros Boulakis
- Physiology of Cognition Lab, GIGA-Cyclotron Research Center In Vivo Imaging, University of Liège, Liège 4000, Belgium
- National Fund for Scientific Research (FNRS), Brussels 1000, Belgium
| | - Sepehr Mortaheb
- Physiology of Cognition Lab, GIGA-Cyclotron Research Center In Vivo Imaging, University of Liège, Liège 4000, Belgium
- National Fund for Scientific Research (FNRS), Brussels 1000, Belgium
| | - Laurens van Calster
- National Fund for Scientific Research (FNRS), Brussels 1000, Belgium
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège 4000, Belgium
- GIGA-Cyclotron Research Center In Vivo Imaging, University of Liège, Liège 4000, Belgium
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
| | - Steve Majerus
- National Fund for Scientific Research (FNRS), Brussels 1000, Belgium
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège 4000, Belgium
- GIGA-Cyclotron Research Center In Vivo Imaging, University of Liège, Liège 4000, Belgium
| | - Athena Demertzi
- Physiology of Cognition Lab, GIGA-Cyclotron Research Center In Vivo Imaging, University of Liège, Liège 4000, Belgium
- National Fund for Scientific Research (FNRS), Brussels 1000, Belgium
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège 4000, Belgium
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50
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Yang Y, He Q, Dang Y, Xia X, Xu X, Chen X, Zhao J, He J. Long-term functional outcomes improved with deep brain stimulation in patients with disorders of consciousness. Stroke Vasc Neurol 2023; 8:368-378. [PMID: 36882201 PMCID: PMC10647871 DOI: 10.1136/svn-2022-001998] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/26/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) has been preliminarily applied to treat patients with disorders of consciousness (DoCs). The study aimed to determine whether DBS was effective for treating patients with DoC and identify factors related to patients' outcomes. METHODS Data from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed. Multivariate regression and subgroup analysis were performed to adjust for potential confounders. The primary outcome was improvement in consciousness at 1 year. RESULTS An overall improvement in consciousness at 1 year was achieved in 32.4% (12/37) of the DBS group compared with 4.3% (14/328) of the conservative group. After full adjustment, DBS significantly improved consciousness at 1 year (adjusted OR 11.90, 95% CI 3.65-38.46, p<0.001). There was a significant treatment×follow up interaction (H=14.99, p<0.001). DBS had significantly better effects in patients with minimally conscious state (MCS) compared with patients with vegetative state/unresponsive wakefulness syndrome (p for interaction <0.001). A nomogram based on age, state of consciousness, pathogeny and duration of DoCs indicated excellent predictive performance (c-index=0.882). CONCLUSIONS DBS was associated with better outcomes in patients with DoC, and the effect was likely to be significantly greater in patients with MCS. DBS should be cautiously evaluated by nomogram preoperatively, and randomised controlled trials are still needed.
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Affiliation(s)
- Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Translational Medicine Center, Chinese Institute for Brain Research, Beijing, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Dang
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Xiaoyu Xia
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Xin Xu
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Xueling Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Academician Office, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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