Title: A modelling approach for describing stimulation and electrophysiological recording of unconscious and conscious brain states
Anna Cattani, Department of Biomedical and Clinical Sciences "Luigi Sacco", Milan, Italy
Abstract:
The clinical assessment of patients with disorder of consciousness critically depends on the patients’ residual ability to create a connection with the outside world by conveying their subjective experience through motor behavior. However, the severity of the brain injury may lead the patient to be unable to perform any kind of movement or adequately understand the required command. For this reason, consciousness may go undetected in brain-injured patients who are unable to communicate. To overcome this clinical problem, it has been developed a theory-driven, objective measure of the level of consciousness (Perturbational Complexity Index – PCI) calculated as the algorithmic complexity of the spatiotemporal pattern of electrophysiological recordings (EEG) obtained by perturbing the cortex with transcranial magnetic stimulation (TMS) (Casali et al. Sci Tr Med 2014). This measure well correlates with the level of consciousness in single individuals and discriminates wakefulness from NREM sleep and anesthesia in healthy subjects, and patients in minimally conscious state (MCS) from patients in unresponsive wakefulness syndrome (UWS). Intracranial recordings in human suggest that in all the conditions in which consciousness is lost, the inescapable occurrence of a down-state after an initial activation could break-off cortico-cortical causal interactions (Pigorini et al. NeuroImage 2015), thus impairing the ability of thalamocortical circuits to sustain long-range, deterministic, complex patterns of activation, a theoretical requisite for consciousness (Tononi et al. Nat Rev Neurosci, 2016).
We employ a modeling approach at both the meso and macro levels (thus paralleling respectively intracranial and TMS/EEG recordings) to investigate at what extent peculiar dynamics at the level of single brain areas and cortico-cortical connections are key ingredients to promote complex causal interactions among different cortical areas (Sarasso et al. Clin EEG Neurosci 2014), and thus consciousness.