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.
Cognitive Neuroscience
July 1, 2010
Marcello Massimini, Fabio Ferrarelli, Michael J. Murphy et al.
205 citations
During the first REM sleep episode of the night, transcranial magnetic stimulation (TMS) triggered widespread and differentiated patterns of cortical activation on electroencephalography (EEG), similar to those observed during wakefulness. In contrast, during NREM sleep, cortical activations became more local and stereotypical, indicating impaired intracortical dialogue. These findings suggest that TMS combined with high-density EEG can probe the internal dialogue of the thalamocortical system, potentially offering a method to assess brain function in patients who are unable to move or communicate.
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.
iScience
May 19, 2023
Andres Ort, John W Smallridge, Simone Sarasso et al.
47 citations
Classical psychedelic drugs like psilocybin induce profound changes in consciousness, including heightened sensory-emotional awareness and arousal, accompanied by increased spontaneous EEG signal diversity. By combining Transcranial Magnetic Stimulation (TMS) with EEG, this work shows that psilocybin creates a state of increased chaotic brain activity, which is not due to altered complexity in causal interactions between brain regions. The study also maps regional effects of psilocybin on TMS-evoked activity, identifying changes in frontal brain structures that may relate to the phenomenology of psychedelic experiences.