Science Translational Medicine
August 14, 2013
Adenauer G. Casali, Olivia Gosseries, Mario Rosanova et al.
1,299 citations
A new index called the perturbational complexity index (PCI) can objectively measure a person's level of consciousness without requiring them to respond or interact. PCI works by using transcranial magnetic stimulation to briefly perturb the cortex and then measuring the algorithmic complexity of the resulting brain activity patterns. The index was tested on healthy individuals during wakefulness, dreaming, nonrapid eye movement sleep, and under sedation with midazolam, xenon, and propofol, as well as on patients who had emerged from coma. PCI reliably distinguished conscious from unconscious states in single individuals across all conditions, including vegetative state, minimally conscious state, and locked-in syndrome.
Annals of Neurology
September 22, 2016
Silvia Casarotto, Angela Comanducci, Mario Rosanova et al.
504 citations
A brain-based measure called the Perturbational Complexity Index (PCI) can reliably distinguish conscious from unconscious individuals, even when they cannot speak or move. The index was first validated in 150 healthy and brain-injured people who could report their conscious state, achieving perfect accuracy in separating conscious from unconscious conditions. Applied to 81 noncommunicative patients, PCI correctly identified 94.7% of those in a minimally conscious state and revealed that 9 of 43 patients diagnosed as vegetative had PCI values overlapping with conscious individuals. These findings suggest that some behaviorally unresponsive patients may retain hidden conscious capacity.
NeuroImage
January 11, 2019
Michele Colombo, Martino Napolitani, Melanie Boly et al.
359 citations
During anesthesia, people may still be conscious even though they do not respond. A marker of consciousness based on the decay rate of the power spectral density (PSD) of resting EEG—measured by the spectral exponent β—was tested in healthy participants under xenon, propofol, or ketamine anesthesia (n=5 per group). Delayed reports indicated whether consciousness was present or absent. Xenon and propofol, which abolish consciousness, caused a steeper PSD decay (more negative β) compared to wakefulness. Ketamine, which preserves consciousness, showed a PSD decay similar to wakefulness overall but a flattening in high frequencies (20–40 Hz). The spectral exponent correlated strongly with the Perturbational Complexity Index (PCI), supporting its use as a marker of consciousness.
Neuroscience of Consciousness
January 1, 2021
Simone Sarasso, Adenauer G. Casali, Silvia Casarotto et al.
183 citations
A growing body of empirical studies has identified complexity-related measures as reliable markers of consciousness across conditions including sleep, anesthesia, hallucinatory states, coma, and related disorders. These measures were proposed independently by researchers working within different frameworks and using diverse methods. This paper systematically reviews that literature, identifies a common denominator among the measures, and traces it to theoretical principles and predictions made over 20 years ago. The authors highlight a consistent trajectory across two decades of consciousness research and offer a provisional taxonomy of the existing work. They argue that this convergence provides a solid foundation for designing future experiments and advancing the field.
Clinical EEG and Neuroscience
January 1, 2014
Simone Sarasso, Mario Rosanova, Adenauer G. Casali et al.
164 citations
Consciousness requires both functional integration and differentiation in the brain, a property termed brain complexity. Transcranial Magnetic Stimulation combined with electroencephalography (TMS/EEG) can quantify this complexity. Studies consistently show that the complexity of the cortical response to TMS collapses during loss of consciousness in deep sleep, anesthesia, and vegetative state after severe brain injury. Complexity recovers when consciousness returns during wakefulness, dreaming, the minimally conscious state, or locked-in syndrome. This approach may help understand the pathophysiology of disorders of consciousness and requires careful methodological attention.
Nature Communications
February 25, 2022
Minji Lee, Leandro Sanz, Alice Barra et al.
120 citations
A deep-learning-based explainable consciousness indicator (ECI) uses EEG responses to transcranial magnetic stimulation and resting-state EEG to separately quantify arousal and awareness. Tested during sleep (n=6), general anesthesia (n=16), and severe brain injury (n=34), ECI distinguishes states such as ketamine-induced anesthesia and rapid eye movement sleep, which combine low arousal with high awareness. Parietal brain regions are most relevant for these measurements. The indicator offers a way to disentangle the two components of consciousness across physiological, pharmacological, and pathological conditions.
Communications biology
August 5, 2024
Charlotte Maschke, Jordan O'Byrne, Michele Angelo Colombo et al.
50 citations
Consciousness may depend on brain activity poised at criticality—a state with complex patterns and high sensitivity to disruption. Analyzing resting-state EEG from healthy volunteers under propofol, xenon, or ketamine anesthesia, the study found that unconsciousness (from propofol or xenon) shifted brain dynamics away from avalanche criticality and the edge of chaos. Ketamine anesthesia preserved consciousness (vivid dreams) and criticality. Dynamical properties from resting EEG accurately predicted individual values of the perturbational complexity index (PCI), a TMS-based consciousness measure. The findings link perturbational complexity to criticality and suggest criticality is necessary for consciousness.
Brain Injury
August 1, 2014
Martino Napolitani, Olivier Bodart, Paola Canali et al.
44 citations
Transcranial magnetic stimulation combined with high-density electroencephalography (TMS-hdEEG) offers advantages over other brain imaging techniques for assessing consciousness. A key requirement for consciousness is the brain's capacity to rapidly integrate information across specialized cortical areas. TMS-EEG stimulates any cortical area and records immediate electrical responses, successfully measuring changes in brain complexity under physiological, pharmacological, and pathological conditions. This technique reliably discriminates between conscious and unconscious patients at the single subject level, though further validation as a clinical tool is needed.
PNAS nexus
December 1, 2024
Emilia Fló, Laouen Belloli, Álvaro Cabana et al.
10 citations
Directing attention toward the body's internal signals (interoception) versus external sounds (exteroception) produces distinct brain activity patterns. Exteroceptive attention flattened overall brain wave power, while interoceptive attention reduced brain signal complexity, increased frontal connectivity and theta oscillations, and modulated the heartbeat-evoked potential (HEP). Classifiers using HEP features correctly identified the attentional state in 17 of 20 healthy participants; power spectral density features classified all 20. In five brain-injured patients, one with unresponsive wakefulness syndrome and one with locked-in syndrome showed willful modulation of the HEP, suggesting they could follow commands. These findings highlight how attention shapes sensory processing and may aid diagnosis in disorders of consciousness.
bioRxiv : the preprint server for biology
October 31, 2023
Charlotte Maschke, Jordan O'Byrne, Michele Angelo Colombo et al.
7 citations
preprint
Consciousness may depend on brain activity poised at criticality, a state with optimal computational properties. Electroencephalograms were recorded from healthy, unresponsive volunteers under propofol, xenon, or ketamine anesthesia. Ketamine spared consciousness (vivid dreams), allowing separation of unresponsiveness from unconsciousness. Unconscious states showed a departure from both the edge of activity propagation and the edge of chaos. The perturbational complexity index (PCI), a sensitive consciousness measure, was predicted from these dynamical properties with a mean absolute error below 7%. Results link PCI to criticality and support criticality's role in consciousness.