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.
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.
PLoS ONE
May 13, 2015
Melanie Boly, Shuntaro Sasai, Olivia Gosseries et al.
69 citations
A meaningful sequence of stimuli, like movie frames, triggers varied experiences, while meaningless stimuli, like TV noise, produce a uniform experience despite physical differences. The differentiation of cortical responses, measured by Lempel-Ziv complexity of functional MRI images, reflects the overall meaningfulness of a stimulus set rather than differences among stimuli. Brain activity patterns showed highest differentiation during a movie, intermediate for a temporally scrambled movie, and minimal for spatially scrambled TV noise, even though overall cortical activation was strong and widespread in all conditions. Meaningfulness also correlated with higher information integration among cortical regions. This approach can assess stimulus meaningfulness without identifying relevant features or neural locations.
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.