Deep Neural Networks for Automatic Classification of Anesthetic-Induced Unconsciousness

Despite the common use of anesthetics to modulate consciousness in the clinic, brain-based monitoring of consciousness is uncommon. We com-bined electroencephalographic measurement of brain activity with deep neural networks to automatically discriminate anesthetic states induced by propofol. Our results with leave-one-participant-out-cross-validation show that convolutional neural networks significantly outperform multilayer perceptrons in discrimination accuracy when working with raw time series. Perceptrons achieved comparable accuracy when provided with power spec-tral densities. These findings highlight the potential of deep convolutional networks for completely automatic extraction of useful spatio-temporo-spectral features from human EEG

Protocol for the Reconstructing Consciousness and Cognition (ReCCognition) Study

Important scientific and clinical questions persist about general anesthesia despite the ubiquitous clinical use of anesthetic drugs in humans since their discovery. For example, it is not known how the brain reconstitutes consciousness and cognition after the profound functional perturbation of the anesthetized state, nor has a specific pattern of functional recovery been characterized. To date, there has been a lack of detailed investigation into rates of recovery and the potential orderly return of attention, sensorimotor function, memory, reasoning and logic, abstract thinking, and processing speed. Moreover, whether such neurobehavioral functions display an invariant sequence of return across individuals is similarly unknown. To address these questions, we designed a study of healthy volunteers undergoing general anesthesia with electroencephalography and serial testing of cognitive functions (NCT01911195). The aims of this study are to characterize the temporal patterns of neurobehavioral recovery over the first several hours following termination of a deep inhaled isoflurane general anesthetic and to identify common patterns of cognitive function recovery. Additionally, we will conduct spectral analysis and reconstruct functional networks from electroencephalographic data to identify any neural correlates (e.g., connectivity patterns, graph-theoretical variables) of cognitive recovery after the perturbation of general anesthesia. To accomplish these objectives, we will enroll a total of 60 consenting adults aged 20–40 across the three participating sites. Half of the study subjects will receive general anesthesia slowly titrated to loss of consciousness (LOC) with an intravenous infusion of propofol and thereafter be maintained for 3 h with 1.3 age adjusted minimum alveolar concentration of isoflurane, while the other half of subjects serves as awake controls to gauge effects of repeated neurobehavioral testing, spontaneous fatigue and endogenous rest-activity patterns

Anesthetic-induced unresponsiveness: Electroencephalographic correlates and subjective experiences

Anesthetic drugs can induce reversible alterations in responsiveness, connectedness and consciousness. The measures based on electroencephalogram (EEG) have marked potential for monitoring the anesthetized state because of their relatively easy use in the operating room. In this study, 79 healthy young men participated in an awake experiment, and 47 participants continued to an anesthesia experiment where they received either dexmedetomidine or propofol as target-controlled infusion with stepwise increments until the loss of responsiveness. The participants were roused during the constant drug infusion and interviewed. The drug dose was increased to 1.5-fold to achieve a deeper unresponsive state. After regaining responsiveness, the participants were interviewed. EEG was measured throughout the experiment and the N400 event-related potential component and functional and directed connectivity were studied. Prefrontal-frontal connectivity in the alpha frequency band discriminated the states that differed with respect to responsiveness or drug concentration. The net direction of connectivity was frontal-to-prefrontal during unresponsiveness and reversed back to prefrontal-to-frontal upon return of responsiveness. The understanding of the meaning of spoken language, as measured with the N400 effect, was lost along with responsiveness but, in the dexmedetomidine group, the N400 component was preserved suggesting partial preservation of the processing of words during anesthetic-induced unresponsiveness. However, the N400 effect could not be detected in all the awake participants and the choice of analysis method had marked impact on its detection rate at the individual-level. Subjective experiences were common during unresponsiveness induced by dexmedetomidine and propofol but the experiences most often suggested disconnectedness from the environment. In conclusion, the doses of dexmedetomidine or propofol minimally sufficient to induce unresponsiveness do not render the participants unconscious and dexmedetomidine does not completely abolish the processing of semantic stimuli. The local anterior EEG connectivity in the alpha frequency band may have potential in monitoring the depth of dexmedetomidine- and propofol-induced anesthesia.Anesteettien aiheuttama vastauskyvyttömyys: aivosähkökäyräpohjaiset korrelaatit ja subjektiiviset kokemukset Anestesialääkkeillä voidaan saada aikaan palautuvia muutoksia vastauskykyisyydessä, kytkeytyneisyydessä ja tajunnassa. Aivosähkökäyrään (EEG) pohjautuvat menetelmät tarjoavat lupaavia mahdollisuuksia mitata anestesian vaikutusta aivoissa, sillä niitä on suhteellisen helppo käyttää leikkaussalissa. Tässä tutkimuksessa 79 tervettä nuorta miestä osallistui valvekokeeseen ja 47 heistä jatkoi anestesiakokeeseen. Anestesiakokeessa koehenkilöille annettiin joko deksmedetomidiinia tai propofolia tavoiteohjattuna infuusiona nousevia annosportaita käyttäen, kunnes he menettivät vastauskykynsä. Koehenkilöt herätettiin tasaisen lääkeinfuusion aikana ja haastateltiin. Koko kokeen ajan mitattiin EEG:tä, josta tutkittiin N400-herätevastetta sekä toiminnallista ja suunnattua konnektiivisuutta. Prefrontaali-frontaalivälillä mitattu konnektiivisuus alfa-taajuuskaistassa erotteli toisistaan tilat, jotka erosivat vastauskykyisyyden tai lääkepitoisuuden suhteen. Konnektiivisuuden vallitseva suunta oli frontaalialueilta prefrontaalialueille vastauskyvyttömyyden aikana, mutta se kääntyi takaisin prefrontaalisesta frontaaliseen kulkevaksi koehenkilöiden vastauskyvyn palatessa. N400-efektillä mitattu puhutun kielen ymmärtäminen katosi vastauskyvyn menettämisen myötä. Deksmedetomidiiniryhmässä N400-komponentti säilyi, mikä viittaa siihen, että anesteettien aiheuttaman vastauskyvyttömyyden aikana sanojen prosessointi voi säilyä osittain. Yksilötasolla N400-efektiä ei kuitenkaan havaittu edes kaikilla hereillä olevilla henkilöillä, ja analyysimenetelmän valinnalla oli suuri vaikutus herätevasteen havaitsemiseen. Subjektiiviset kokemukset olivat yleisiä deksmedetomidiinin ja propofolin aiheuttaman vastauskyvyttömyyden aikana, mutta kokemukset olivat usein ympäristöstä irtikytkeytyneitä. Yhteenvetona voidaan todeta, että deksmedetomidiini- ja propofoliannokset, jotka juuri ja juuri riittävät aikaansaamaan vastauskyvyttömyyden, eivät aiheuta tajuttomuutta. Deksmedetomidiini ei myöskään täysin estä merkityssisällöllisten ärsykkeiden käsittelyä. Frontaalialueen sisällä EEG:llä mitattu konnektiivisuus alfataajuuskaistassa saattaa olla tulevaisuudessa hyödyllinen menetelmä deksmedetomidiini- ja propofolianestesian syvyyden mittaamiseksi

Monosynaptic Functional Connectivity in Cerebral Cortex During Wakefulness and Under Graded Levels of Anesthesia

The balance between excitation and inhibition is considered to be of significant importance for neural computation and cognitive function. Excitatory and inhibitory functional connectivity in intact cortical neuronal networks in wakefulness and graded levels of anesthesia has not been systematically investigated. We compared monosynaptic excitatory and inhibitory spike transmission probabilities using pairwise cross-correlogram (CCG) analysis. Spikes were measured at 64 sites in the visual cortex of rats with chronically implanted microelectrode arrays during wakefulness and three levels of anesthesia produced by desflurane. Anesthesia decreased the number of active units, the number of functional connections, and the strength of excitatory connections. Connection probability (number of connections per number of active unit pairs) was unaffected until the deepest anesthesia level, at which a significant increase in the excitatory to inhibitory ratio of connection probabilities was observed. The results suggest that the excitatory–inhibitory balance is altered at an anesthetic depth associated with unconsciousness

EEG-Based Automatic Classification of ‘Awake’ versus ‘Anesthetized’ State in General Anesthesia Using Granger Causality

BACKGROUND: General anesthesia is a reversible state of unconsciousness and depression of reflexes to afferent stimuli induced by administration of a "cocktail" of chemical agents. The multi-component nature of general anesthesia complicates the identification of the precise mechanisms by which anesthetics disrupt consciousness. Devices that monitor the depth of anesthesia are an important aide for the anesthetist. This paper investigates the use of effective connectivity measures from human electrical brain activity as a means of discriminating between 'awake' and 'anesthetized' state during induction and recovery of consciousness under general anesthesia. METHODOLOGY/PRINCIPAL FINDINGS: Granger Causality (GC), a linear measure of effective connectivity, is utilized in automated classification of 'awake' versus 'anesthetized' state using Linear Discriminant Analysis and Support Vector Machines (with linear and non-linear kernel). Based on our investigations, the most characteristic change of GC observed between the two states is the sharp increase of GC from frontal to posterior regions when the subject was anesthetized, and reversal at recovery of consciousness. Features derived from the GC estimates resulted in classification of 'awake' and 'anesthetized' states in 21 patients with maximum average accuracies of 0.98 and 0.95, during loss and recovery of consciousness respectively. The differences in linear and non-linear classification are not statistically significant, implying that GC features are linearly separable, eliminating the need for a complex and computationally expensive non-linear classifier. In addition, the observed GC patterns are particularly interesting in terms of a physiological interpretation of the disruption of consciousness by anesthetics. Bidirectional interaction or strong unidirectional interaction in the presence of a common input as captured by GC are most likely related to mechanisms of information flow in cortical circuits. CONCLUSIONS/SIGNIFICANCE: GC-based features could be utilized effectively in a device for monitoring depth of anesthesia during surgery

Deep Learning for Electrophysiological Investigation and Estimation of Anesthetic-Induced Unconsciousness

Neuroscience has made a number of advances in the search for the neural correlates of consciousness, but our understanding of the neurophysiological markers remains incomplete. In this work, we apply deep learning techniques to resting-state electroencephalographic (EEG) measures of healthy participants under general anesthesia, for the investigation and estimation of altered states of consciousness. Specifically, we focus on states characterized by different levels of unconsciousness and anesthetic depths, based on definitions and metrics from contemporary clinical practice. Our experiments begin by exploring the ability of deep learning to extract relevant electrophysiological features, under a cross-subject decoding task. As there is no state-of-theart model for EEG analysis, we compare two widely used deep learning architectures - convolutional neural networks (cNNs) and multilayer perceptrons (MLPs) - and show that cNNs perform effectively, using only one second of the raw EEG signals. Relying on cNNs, we derive a novel 3D architecture design and a standard preprocessing pipeline, which allows us to exploit the spatio-temporal structure of the EEG, as well as to integrate different acquisition systems and datasets under a common methodology. We then focus on the nature of different predictive tasks, by investigating classification and regression algorithms under a variety of clinical ground-truths, based on behavioral, pharmacological, and psychometrical evidence for consciousness. Our findings provide several insights regarding the interaction across the anesthetic states, the electrophysiological signatures, and the temporal dynamics of the models. We also reveal an optimal training strategy, based on which we can detect progressive changes in levels of unconsciousness, with higher granularity than current clinical methods. Finally, we test the generalizability of our deep learning-based EEG framework, across subjects, experimental designs, and anesthetic agents (propofol, ketamine and xenon). Our results highlight the capacity of our model to acquire appropriate, task-related, cross-study features, and the potential to discover common cross-drug features of unconsciousness. This work has broader significance for discovering generalized electrophysiological markers that index states of consciousness, using a data-driven analysis approach. It also provides a basis for the development of automated, machine-learning driven, non-invasive EEG systems for real-time monitoring of the depth of anesthesia, which can advance patients' comfort and safety

Functional integration in the cortical neuronal network of conscious and anesthetized animals

General anesthesia consists of amnesia, analgesia, areflexia and unconsciousness. How anesthetics suppress consciousness has been a mystery for more than one and a half centuries. The overall goal of my research has been to determine the neural correlates of anesthetic-induced loss of consciousness. I hypothesized that anesthetics induce unconsciousness by interfering with the functional connectivity of neuronal networks of the brain and consequently, reducing the brain\u27s capacity for information processing. To test this hypothesis, I performed experiments in which neuronal spiking activity was measured with chronically implanted microelectrode arrays in the visual cortex of freely-moving rats during wakefulness and at graded levels of anesthesia produced by the inhalational anesthetic agent desflurane. I then applied linear and non-parametric information-theoretic analyses to quantify the concentration-dependent effect of general anesthetics on spontaneous and visually evoked spike firing activity in rat primary visual cortex. Results suggest that desflurane anesthesia disrupts cortical neuronal integration as measured by monosynaptic connectivity, spike burst coherence and information capacity. This research furthers our understanding of the mechanisms involved with the anesthetic-induced LOC which may facilitate in the development of better anesthetic monitoring devices and the creation of effective anesthetic agents that will be free of unwanted side effects

Monitoring the Depth of Anaesthesia

One of the current challenges in medicine is monitoring the patients’ depth of general anaesthesia (DGA). Accurate assessment of the depth of anaesthesia contributes to tailoring drug administration to the individual patient, thus preventing awareness or excessive anaesthetic depth and improving patients’ outcomes. In the past decade, there has been a significant increase in the number of studies on the development, comparison and validation of commercial devices that estimate the DGA by analyzing electrical activity of the brain (i.e., evoked potentials or brain waves). In this paper we review the most frequently used sensors and mathematical methods for monitoring the DGA, their validation in clinical practice and discuss the central question of whether these approaches can, compared to other conventional methods, reduce the risk of patient awareness during surgical procedures

A mean field approach to model levels of consciousness from EEG recordings

We introduce a mean-field model for analysing the dynamics of human consciousness. In particular, inspired by the Giulio Tononi's Integrated Information Theory and by the Max Tegmark's representation of consciousness, we study order-disorder phase transitions on Curie-Weiss models generated by processing EEG signals. The latter have been recorded on healthy individuals undergoing deep sedation. Then, we implement a machine learning tool for classifying mental states using, as input, the critical temperatures computed in the Curie-Weiss models. Results show that, by the proposed method, it is possible to discriminate between states of awareness and states of deep sedation. Besides, we identify a state space for representing the path between mental states, whose dimensions correspond to critical temperatures computed over different frequency bands of the EEG signal. Beyond possible theoretical implications in the study of human consciousness, resulting from our model, we deem relevant to emphasise that the proposed method could be exploited for clinical applications.Comment: 23 pages, 6 figures. Accepted for publication in Journal of Statistical Mechanics: Theory and Experimen