Human Cortical Excitability Increases with Time Awake

Prolonged wakefulness is associated not only with obvious changes in the way we feel and perform but also with well-known clinical effects, such as increased susceptibility to seizures, to hallucinations, and relief of depressive symptoms. These clinical effects suggest that prolonged wakefulness may be associated with significant changes in the state of cortical circuits. While recent animal experiments have reported a progressive increase of cortical excitability with time awake, no conclusive evidence could be gathered in humans. In this study, we combine transcranial magnetic stimulation (TMS) and electroencephalography (EEG) to monitor cortical excitability in healthy individuals as a function of time awake. We observed that the excitability of the human frontal cortex, measured as the immediate (0-20 ms) EEG reaction to TMS, progressively increases with time awake, from morning to evening and after one night of total sleep deprivation, and that it decreases after recovery sleep. By continuously monitoring vigilance, we also found that this modulation in cortical responsiveness is tonic and not attributable to transient fluctuations of the level of arousal. The present results provide noninvasive electrophysiological evidence that wakefulness is associated with a steady increase in the excitability of human cortical circuits that is rebalanced during slee

Consciousness Regained: Disentangling Mechanisms, Brain Systems, and Behavioral Responses

How consciousness (experience) arises from and relates to material brain processes (the "mind-body problem") has been pondered by thinkers for centuries, and is regarded as among the deepest unsolved problems in science, with wide-ranging theoretical, clinical, and ethical implications. Until the last few decades, this was largely seen as a philosophical topic, but not widely accepted in mainstream neuroscience. Since the 1980s, however, novel methods and theoretical advances have yielded remarkable results, opening up the field for scientific and clinical progress. Since a seminal paper by Crick and Koch (1998) claimed that a science of consciousness should first search for its neural correlates (NCC), a variety of correlates have been suggested, including both content-specific NCCs, determining particular phenomenal components within an experience, and the full NCC, the neural substrates supporting entire conscious experiences. In this review, we present recent progress on theoretical, experimental, and clinical issues. Specifically, we (1) review methodological advances that are important for dissociating conscious experience from related enabling and executive functions, (2) suggest how critically reconsidering the role of the frontal cortex may further delineate NCCs, (3) advocate the need for general, objective, brain-based measures of the capacity for consciousness that are independent of sensory processing and executive functions, and (4) show how animal studies can reveal population and network phenomena of relevance for understanding mechanisms of consciousness.European Union's Horizon 2020 Research and Innovation ProgrammeHermann and Lilly Schilling FoundationGerman Research FoundationCenter for Nanoscale Microscopy and Molecular Physiology of the BrainNational Institutes of Health/National Institute of Neurological Disorders and StrokeSao Paulo Research FoundationJames S. McDonnell Foundation Scholar AwardEU Grant H2020-FETOPENCanadian Institute for Advanced ResearchAzrieli Program in Brain, Mind and ConsciousnessFLAG-ERA JTC project CANONNorwegian Research CouncilNetherlands Organization for Scientific ResearchUniv Oslo, Inst Basal Med Sci, Div Physiol, Dept Mol Med, POB 1103 Blindern, N-0317 Oslo, NorwayUniv Wisconsin, Dept Neurol, Madison, WI 53705 USAUniv Wisconsin, Dept Psychiat, Madison, WI 53719 USAUniv Fed Sao Paulo, Inst Sci & Technol, BR-12231280 Sao Jose Dos Campos, SP, BrazilUniv Milan, Dept Biomed & Clin Sci Luigi Sacco, I-20157 Milan, ItalyFdn Don Carlo Gnocchi ONLUS, Ist Ricovero & Cura Carattere Sci, I-20162 Milan, ItalyUniv Amsterdam, Swammerdam Inst Life Sci, Cognit & Syst Neurosci Grp, NL-1098 XH Amsterdam, NetherlandsUniv Amsterdam, Res Prior Program Brain & Cognit, NL-1098 XH Amsterdam, NetherlandsUniv Med Goettingen, Dept Cognit Neurol, D-37075 Gottingen, GermanyLeibniz Inst Primate Res, German Primate Ctr, D-37077 Gottingen, GermanyLeibniz Sci Campus Primate Cognit, D-37077 Gottingen, GermanyUniv Fed Sao Paulo, Inst Sci & Technol, BR-12231280 Sao Jose Dos Campos, SP, BrazilEuropean Union's Horizon 2020 Research and Innovation Programme: 720270German Research Foundation: WI 4046/1-1National Institutes of Health/National Institute of Neurological Disorders and Stroke: 1R03NS096379FAPESP: 2016/08263-9EU Grant H2020-FETOPEN: RIA 686764Web of Scienc

EEG Responses to TMS Are Sensitive to Changes in the Perturbation Parameters and Repeatable over Time

BACKGROUND: High-density electroencephalography (hd-EEG) combined with transcranial magnetic stimulation (TMS) provides a direct and non-invasive measure of cortical excitability and connectivity in humans and may be employed to track over time pathological alterations, plastic changes and therapy-induced modifications in cortical circuits. However, the diagnostic/monitoring applications of this technique would be limited to the extent that TMS-evoked potentials are either stereotypical (non-sensitive) or random (non-repeatable) responses. Here, we used controlled changes in the stimulation parameters (site, intensity, and angle of stimulation) and repeated longitudinal measurements (same day and one week apart) to evaluate the sensitivity and repeatability of TMS/hd-EEG potentials. METHODOLOGY/PRINCIPAL FINDINGS: In 10 volunteers, we performed 92 single-subject comparisons to evaluate the similarities/differences between pairs of TMS-evoked potentials recorded in the same/different stimulation conditions. For each pairwise comparison, we used non-parametric statistics to calculate a Divergence Index (DI), i.e., the percentage of samples that differed significantly, considering all scalp locations and the entire post-stimulus period. A receiver operating characteristic analysis showed that it was possible to find an optimal DI threshold of 1.67%, yielding 96.7% overall accuracy of TMS/hd-EEG in detecting whether a change in the perturbation parameters occurred or not. CONCLUSIONS/SIGNIFICANCE: These results demonstrate that the EEG responses to TMS essentially reflect deterministic properties of the stimulated neuronal circuits as opposed to stereotypical responses or uncontrolled variability. To the extent that TMS-evoked potentials are sensitive to changes and repeatable over time, they may be employed to detect longitudinal changes in the state of cortical circuits

Brane World Cosmological Perturbations

We consider a brane world and its gravitational linear perturbations. We present a general solution of the perturbations in the bulk and find the complete perturbed junction conditions for generic brane dynamics. We also prove that (spin 2) gravitational waves in the great majority of cases can only arise in connection with a non-vanishing anisotropic stress. This has far reaching consequences for inflation in the brane world. Moreover, contrary to the case of the radion, perturbations are stable.Comment: 16 pages, one figur

Recovery of cortical effective connectivity and recovery of consciousness in vegetative patients

Patients surviving severe brain injury may regain consciousness without recovering their ability to understand, move and communicate. Recently, electrophysiological and neuroimaging approaches, employing simple sensory stimulations or verbal commands, have proven useful in detecting higher order processing and, in some cases, in establishing some degree of communication in brain-injured subjects with severe impairment of motor function. To complement these approaches, it would be useful to develop methods to detect recovery of consciousness in ways that do not depend on the integrity of sensory pathways or on the subject's ability to comprehend or carry out instructions. As suggested by theoretical and experimental work, a key requirement for consciousness is that multiple, specialized cortical areas can engage in rapid causal interactions (effective connectivity). Here, we employ transcranial magnetic stimulation together with high-density electroencephalography to evaluate effective connectivity at the bedside of severely brain injured, non-communicating subjects. In patients in a vegetative state, who were open-eyed, behaviourally awake but unresponsive, transcranial magnetic stimulation triggered a simple, local response indicating a breakdown of effective connectivity, similar to the one previously observed in unconscious sleeping or anaesthetized subjects. In contrast, in minimally conscious patients, who showed fluctuating signs of non-reflexive behaviour, transcranial magnetic stimulation invariably triggered complex activations that sequentially involved distant cortical areas ipsi- and contralateral to the site of stimulation, similar to activations we recorded in locked-in, conscious patients. Longitudinal measurements performed in patients who gradually recovered consciousness revealed that this clear-cut change in effective connectivity could occur at an early stage, before reliable communication was established with the subject and before the spontaneous electroencephalogram showed significant modifications. Measurements of effective connectivity by means of transcranial magnetic stimulation combined with electroencephalography can be performed at the bedside while by-passing subcortical afferent and efferent pathways, and without requiring active participation of subjects or language comprehension; hence, they offer an effective way to detect and track recovery of consciousness in brain-injured patients who are unable to exchange information with the external environment

Editor's Summary

Manipulation of consciousness is an everyday medical trick−−think anesthesia−−but physicians have only the crudest of tools to detect when a person is not aware. The usual question or physical stimulus does not always provide reliable reactions, and a more precise index is needed to avoid, for example, the conclusion that people who have locked-in syndrome (in which they are aware but cannot respond) are unconscious. Here, Casali et al. have extended their previous work on electrical correlates of consciousness to define an electroencephalographic-derived index of human consciousness [the perturbational complexity index (PCI)] that reflects the information content of the brain's response to a magnetic stimulus. The PCI could allow tracking of consciousness in individual patients. The authors used data already collected from previous experiments, in which they had stimulated people's brains with transcranial magnetic stimulation. By calculating the likely brain regional sources of the signals and then comparing the unique information in each, the authors derived PCI values. The values ranged from 0.44 to 0.67 in 32 awake healthy people, but fell to 0.18 to 0.28 during nonrapid eye movement (NREM) sleep. Then, to see whether a completely different way of inducing unconsciousness had the same effect on PCI, the authors assessed data from patients given various amounts of the anesthetics midazolam, xenon, and propofol. These agents too caused low ''unconscious' ' values for the PCI: midazolam deep sedation, 0.23 to 0.31; propofol, 0.13 to 0.30; and xenon, 0.12 to 0.31

General Anesthesia Disrupts Complex Cortical Dynamics in Response to Intracranial Electrical Stimulation in Rats

The capacity of human brain to sustain complex cortical dynamics appears to be strongly associated with conscious experience and consistently drops when consciousness fades. For example, several recent studies in humans found a remarkable reduction of the spatiotemporal complexity of cortical responses to local stimulation during dreamless sleep, general anesthesia, and coma. However, this perturbational complexity has never been directly estimated in non-human animals in vivo previously, and the mechanisms that prevent neocortical neurons to engage in complex interactions are still unclear. Here, we quantify the complexity of electroencephalographic (EEG) responses to intracranial electrical stimulation in rats, comparing wakefulness to propofol, sevoflurane, and ketamine anesthesia. The evoked activity changed from highly complex in wakefulness to far simpler with propofol and sevoflurane. The reduced complexity was associated with a suppression of high frequencies that preceded a reduced phase-locking, and disruption of functional connectivity and pattern diversity. We then showed how these parameters dissociate with ketamine and depend on intensity and site of stimulation. Our results support the idea that brief periods of activity-dependent neuronal silence can interrupt complex interactions in neocortical circuits, and open the way for further mechanistic investigations of the neuronal basis for consciousness and loss of consciousness across species

A Theoretically Based Index of Consciousness Independent of Sensory Processing and Behavior

One challenging aspect of the clinical assessment of brain-injured, unresponsive patients is the lack of an objective measure of consciousness that is independent of the subject's ability to interact with the external environment. Theoretical considerations suggest that consciousness depends on the brain's ability to support complex activity patterns that are, at once, distributed among interacting cortical areas (integrated) and differentiated in space and time (information-rich). We introduce and test a theory-driven index of the level of consciousness called the perturbational complexity index (PCI). PCI is calculated by (i) perturbing the cortex with transcranial magnetic stimulation (TMS) to engage distributed interactions in the brain (integration) and (ii) compressing the spatiotemporal pattern of these electrocortical responses to measure their algorithmic complexity (information). We test PCI on a large data set of TMS-evoked potentials recorded in healthy subjects during wakefulness, dreaming, nonrapid eye movement sleep, and different levels of sedation induced by anesthetic agents (midazolam, xenon, and propofol), as well as in patients who had emerged from coma (vegetative state, minimally conscious state, and locked-in syndrome). PCI reliably discriminated the level of consciousness in single individuals during wakefulness, sleep, and anesthesia, as well as in patients who had emerged from coma and recovered a minimal level of consciousness. PCI can potentially be used for objective determination of the level of consciousness at the bedside.Belgian National Funds for Scientific Research (FNRS)EUPURDote ricerca: FSE, Regione Lombardia (University of Milan)Prin2008 (Italian Government)Fonds Leon Fredericq, James S. McDonnell FoundationMind Science FoundationEuropean Commission (Mindbridge, DISCOS, DECODER COST)Concerted Research ActionPublic Utility Foundation Universite Europeenne du TravailFondazione Europea di Ricerca BiomedicaUniv Milan, Dept Biomed & Clin Sci Luigi Sacco, I-20157 Milan, ItalyUniv Liege, Univ Hosp, Cyclotron Res Ctr, Coma Sci Grp, B-4000 Liege, BelgiumUniv Liege, Univ Hosp, Dept Neurol, B-4000 Liege, BelgiumUniversidade Federal de São Paulo, Inst Sci & Technol, BR-12231280 Sao Jose Dos Campos, BrazilUniv Wisconsin, Dept Psychiat, Madison, WI 53719 USAFdn Don Carlo Gnocchi, Ist Ricovero Cura Carattere Sci, I-20148 Milan, ItalyUniversidade Federal de São Paulo, Inst Sci & Technol, BR-12231280 Sao Jose Dos Campos, BrazilEU: FP7-ICT-2011-9EU: 600806Concerted Research Action: ARC 06/11-340Web of Scienc