Predicting the outcome of post-anoxic comatose patients based on single-trial EEG analysis

Les maladies cardio-vasculaires représentent la première cause de mortalité en Suisse. Après un arrêt cardio-respiratoire, une minorité des patients survit sans ou avec peu de séquelles fonctionnelles. L'évaluation du pronostic se fait classiquement selon des critères établis par l'Académie Américaine de Neurologie (AAN) en 2006, soit précédant l'introduction de l'hypothermie thérapeutique. Depuis, ces critères semblent insuffisants, et de nouveaux examens para-cliniques sont nécessaires afin d'identifier les patients ayant un pronostic favorable. La détection d'irrégularités auditives, et plus particulièrement l'évolution de cette détection sur plusieurs jours, pourrait être un indicateur du pronostic de patients comateux suite à une anoxie cérébrale. En effet, lors d'une violation de la régularité établie par des séries de sons identiques, deux signaux sont détectables à l'électro- encéphalographie (EEG). Le premier, dénommé «Mismatch negativity» (MMN), peut être enregistré après une violation locale d'une régularité établie au niveau de chaque son. Il reflète un processus inconscient et ne demandant pas de ressources attentionnelles. Le deuxième, dénommé « complexe P300 » survient par contre après une violation globale d'une régularité établie au niveau de groupes de sons. La littérature actuelle indique que ce deuxième phénomène requerrait la présence de capacités attentionnelles. Dans notre étude, nous avons testé l'existence de cette détection d'irrégularités auditives globales chez des patients dans une phase précoce de coma post-anoxique, sous hypothermie thérapeutique. Nous avons enregistré la réponse électro-encéphalographique lors de violations de régularités auditives globales, à l'aide d'un protocole expérimental qui intégrait en plus un paradigme de MMN classique, afin de tester la détection d'irrégularités auditives locales également. Notre analyse finale inclut 24 patients comateux ayant subi un arrêt cardio-respiratoire, et bénéficié du protocole hypothermie du Centre Hospitalier Universitaire Vaudois (CHUV) à Lausanne. Après une analyse multivariée des réponses électro-encéphalographiques de chaque tracé individuellement (« single-trial »), nous avons trouvé que 8 patients sur 24 pouvaient discriminer une irrégularité globale, alors qu'étant définis comateux selon l'échelle de Glasgow (GCS). De plus, l'amélioration de la détection d' irrégularités auditives entre deux EEG consécutifs (en hypo- puis normothermie), était un facteur de bon pronostic. Notre test pourrait ainsi être un complément para-clinique dans l'évaluation du pronostic de patients en coma post- anoxique

Stratification of unresponsive patients by an independently validated index of brain complexity.

OBJECTIVE: Validating objective, brain-based indices of consciousness in behaviorally unresponsive patients represents a challenge due to the impossibility of obtaining independent evidence through subjective reports. Here we address this problem by first validating a promising metric of consciousness-the Perturbational Complexity Index (PCI)-in a benchmark population who could confirm the presence or absence of consciousness through subjective reports, and then applying the same index to patients with disorders of consciousness (DOCs). METHODS: The benchmark population encompassed 150 healthy controls and communicative brain-injured subjects in various states of conscious wakefulness, disconnected consciousness, and unconsciousness. Receiver operating characteristic curve analysis was performed to define an optimal cutoff for discriminating between the conscious and unconscious conditions. This cutoff was then applied to a cohort of noncommunicative DOC patients (38 in a minimally conscious state [MCS] and 43 in a vegetative state [VS]). RESULTS: We found an empirical cutoff that discriminated with 100% sensitivity and specificity between the conscious and the unconscious conditions in the benchmark population. This cutoff resulted in a sensitivity of 94.7% in detecting MCS and allowed the identification of a number of unresponsive VS patients (9 of 43) with high values of PCI, overlapping with the distribution of the benchmark conscious condition. INTERPRETATION: Given its high sensitivity and specificity in the benchmark and MCS population, PCI offers a reliable, independently validated stratification of unresponsive patients that has important physiopathological and therapeutic implications. In particular, the high-PCI subgroup of VS patients may retain a capacity for consciousness that is not expressed in behavior

Evidence of trace conditioning in comatose patients revealed by the reactivation of EEG responses to alerting sounds.

Trace conditioning refers to a learning process occurring after repeated presentation of a neutral conditioned stimulus (CS+) and a salient unconditioned stimulus (UCS) separated by a temporal gap. Recent studies have reported that trace conditioning can occur in humans in reduced levels of consciousness by showing a transfer of the unconditioned autonomic response to the CS+ in healthy sleeping individuals and in vegetative state patients. However, no previous studies have investigated the neural underpinning of trace conditioning in the absence of consciousness in humans. In the present study, we recorded the EEG activity of 29 post-anoxic comatose patients while presenting a trace conditioning paradigm using neutral tones as CS+ and alerting sounds as UCS. Most patients received therapeutic hypothermia and all were deeply unconscious according to standardized clinical scales. After repeated presentation of the CS+ and UCS couple, learning was assessed by measuring the EEG activity during the period where the UCS is omitted after CS+ presentation. Specifically we assessed the 'reactivation' of the neural response to UCS omission by applying a decoding algorithm derived from the statistical model of the EEG activity in response to the UCS presentation. The same procedure was used in a group of 12 awake healthy controls. We found a reactivation of the UCS response in absence of stimulation in eight patients (five under therapeutic hypothermia) and four healthy controls. Additionally, the reactivation effect was temporally specific within trials since it manifested primarily at the specific latency of UCS presentation and significantly less before or after this period. Our results show for the first time that trace conditioning may manifest as a reactivation of the EEG activity related to the UCS and even in the absence of consciousness

Prediction Under Uncertainty: Dissociating Sensory from Cognitive Expectations in Highly Uncertain Musical Contexts

Predictive models in the brain rely on the continuous extraction of regularities from the environment. These models are thought to be updated by novel information, as reflected in prediction error responses such as the mismatch negativity (MMN). However, although in real life individuals often face situations in which uncertainty prevails, it remains unclear whether and how predictive models emerge in high-uncertainty contexts. Recent research suggests that uncertainty affects the magnitude of MMN responses in the context of music listening. However, musical predictions are typically studied with MMN stimulation paradigms based on Western tonal music, which are characterized by relatively high predictability. Hence, we developed an MMN paradigm to investigate how the high uncertainty of atonal music modulates predictive processes as indexed by the MMN and behavior. Using MEG in a group of 20 subjects without musical training, we demonstrate that the magnetic MMN in response to pitch, intensity, timbre, and location deviants is evoked in both tonal and atonal melodies, with no significant differences between conditions. In contrast, in a separate behavioral experiment involving 39 non-musicians, participants detected pitch deviants more accurately and rated confidence higher in the tonal than in the atonal musical context. These results indicate that contextual tonal uncertainty modulates processing stages in which conscious awareness is involved, although deviants robustly elicit low-level pre-attentive responses such as the MMN. The achievement of robust MMN responses, despite high tonal uncertainty, is relevant for future studies comparing groups of listeners’ MMN responses to increasingly ecological music stimuli

Stratification of unresponsive patients by an independently validated index of brain complexity

Objective: Validating objective, brain-based indices of consciousness in behaviorally unresponsive patients represents a challenge due to the impossibility of obtaining independent evidence through subjective reports. Here we address this problem by first validating a promising metric of consciousness\u2014the Perturbational Complexity Index (PCI)\u2014in a benchmark population who could confirm the presence or absence of consciousness through subjective reports, and then applying the same index to patients with disorders of consciousness (DOCs). Methods: The benchmark population encompassed 150 healthy controls and communicative brain-injured subjects in various states of conscious wakefulness, disconnected consciousness, and unconsciousness. Receiver operating characteristic curve analysis was performed to define an optimal cutoff for discriminating between the conscious and unconscious conditions. This cutoff was then applied to a cohort of noncommunicative DOC patients (38 in a minimally conscious state [MCS] and 43 in a vegetative state [VS]). Results: We found an empirical cutoff that discriminated with 100% sensitivity and specificity between the conscious and the unconscious conditions in the benchmark population. This cutoff resulted in a sensitivity of 94.7% in detecting MCS and allowed the identification of a number of unresponsive VS patients (9 of 43) with high values of PCI, overlapping with the distribution of the benchmark conscious condition. Interpretation: Given its high sensitivity and specificity in the benchmark and MCS population, PCI offers a reliable, independently validated stratification of unresponsive patients that has important physiopathological and therapeutic implications. In particular, the high-PCI subgroup of VS patients may retain a capacity for consciousness that is not expressed in behavior. Ann Neurol 2016;80:718\u2013729

Group-Level Multivariate Analysis in EasyEEG Toolbox: Examining the Temporal Dynamics Using Topographic Responses

Electroencephalography (EEG) provides high temporal resolution cognitive information from non-invasive recordings. However, one of the common practices–using a subset of sensors in ERP analysis is hard to provide a holistic and precise dynamic results. Selecting or grouping subsets of sensors may also be subject to selection bias, multiple comparison, and further complicated by individual differences in the group-level analysis. More importantly, changes in neural generators and variations in response magnitude from the same neural sources are difficult to separate, which limit the capacity of testing different aspects of cognitive hypotheses. We introduce EasyEEG, a toolbox that includes several multivariate analysis methods to directly test cognitive hypotheses based on topographic responses that include data from all sensors. These multivariate methods can investigate effects in the dimensions of response magnitude and topographic patterns separately using data in the sensor space, therefore enable assessing neural response dynamics. The concise workflow and the modular design provide user-friendly and programmer-friendly features. Users of all levels can benefit from the open-sourced, free EasyEEG to obtain a straightforward solution for efficient processing of EEG data and a complete pipeline from raw data to final results for publication

A transient cortical state with sleep-like sensory responses precedes emergence from general anesthesia in humans

During awake consciousness, the brain intrinsically maintains a dynamical state in which it can coordinate complex responses to sensory input. How the brain reaches this state spontaneously is not known. General anesthesia provides a unique opportunity to examine how the human brain recovers its functional capabilities after profound unconsciousness. We used intracranial electrocorticography and scalp EEG in humans to track neural dynamics during emergence from propofol general anesthesia. We identify a distinct transient brain state that occurs immediately prior to recovery of behavioral responsiveness. This state is characterized by large, spatially distributed, slow sensory-evoked potentials that resemble the K-complexes that are hallmarks of stage two sleep. However, the ongoing spontaneous dynamics in this transitional state differ from sleep. These results identify an asymmetry in the neurophysiology of induction and emergence, as the emerging brain can enter a state with a sleep-like sensory blockade before regaining responsivity to arousing stimuli.National Institutes of Health (U.S.) (Grant K99-MH111748)National Institutes of Health (U.S.) (Grant R00-NS080911)National Institutes of Health (U.S.) (Grant DP2-OD006454)National Institutes of Health (U.S.) (Grant S10-RR023401)National Institutes of Health (U.S.) (Grant R01- NS062092)National Institutes of Health (U.S.) (Grant R01AG056015)National Institutes of Health (U.S.) (Grant P01GM118269)National Institutes of Health (U.S.) (Grant R01-EB009282

Bayne, T. & Shea, N. (2020), ‘Consciousness, Concepts, and Natural Kinds’, Philosophical Topics 48(1), 65-84.

We have various everyday measures for identifying the presence of consciousness, such as the capacity for verbal report and the intentional control of behaviour. However, there are many contexts in which these measures are difficult (if not impossible) to apply, and even when they can be applied one might have doubts as to their validity in determining the presence/absence of consciousness. Everyday measures for identifying consciousness are particularly problematic when it comes to ‘challenging cases’—human infants, people with brain damage, non-human animals, and AI systems. There is a pressing need to identify measures of consciousness that can be applied to challenging cases. This paper explores one of the most promising strategies for identifying and validating such measures—the natural kind strategy. The paper is in two broad parts. Part I introduces the natural kind strategy, and contrasts it with other influential approaches in the field. Part II considers a number of objections to the approach, arguing that none succeeds