Response to comment on "preserved feedforward but impaired top-down processes in the vegetative state".

King et al. raise some technical issues about our recent study showing impaired top-down processes in the vegetative state. We welcome the opportunity to provide more details about our methods and results and to resolve their concerns. We substantiate our interpretation of the results and provide a point-by-point response to the issues raised.Peer reviewe

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

HPLC ANALYSIS AND ANTI-INFLAMMATORY PROPERTIES STUDIES OF TRUNK BARKS OF ACACIA NILOTICA VAR ADANSONII (GUILL AND PERR) O KTZE (MIMOSACEAE)

Objective: The objective of this study was to evaluate the in vitro and in vivo anti-inflammatory properties of the aqueous extract and fractions of the trunk bark of Acacia nilotica. Methods: A maceration of the powder of the trunks barks of the plant was realized. Then the aqueous macerate obtained was fractionated with dichloromethane, butanol and ethyl acetate successively. The phenolic compounds of the aqueous extract, butanol and ethyl acetate fractions were identified by HPLC/DAD. Lipoxygenase and phospholipase inhibition tests with the aqueous extract and the butanol and ethyl acetate fractions were carried out. The anti-inflammatory potential of the aqueous extract was assessed in vivo by the anti-edema test with carrageenan and the analgesic test with acetic acid at different doses (200 mg/ml; 400 mg/ml; 600 mg/ml). Aspirin (200 mg/ml) and paracetamol (200 mg/ml) were used as a reference. Results: The HPLC/DAD analysis of the extracts revealed that gallic acid is the most abundant phenol acid in the extracts. The aqueous extract inhibited lipoxygenase (IC50 = 18.32±1.18 μg/ml), phospholipase (11.44±0.32% per 100 μg/ml) and cyclooxygenase (56.48±0.29% for 100 μg/ml) as well as its tested fractions. It also reduced edema and pain in the mice by more than 50% from the 400 mg/ml dose. Conclusion: Aqueous extract of Acacia nilotica has anti-inflammatory properties. Hence its use in traditional medicine in the treatment of inflammation

Complexity of multi-dimensional spontaneous EEG decreases during propofol induced general anaesthesia

Emerging neural theories of consciousness suggest a correlation between a specific type of neural dynamical complexity and the level of consciousness: When awake and aware, causal interactions between brain regions are both integrated (all regions are to a certain extent connected) and differentiated (there is inhomogeneity and variety in the interactions). In support of this, recent work by Casali et al (2013) has shown that Lempel-Ziv complexity correlates strongly with conscious level, when computed on the EEG response to transcranial magnetic stimulation. Here we investigated complexity of spontaneous high-density EEG data during propofol-induced general anaesthesia. We consider three distinct measures: (i) Lempel-Ziv complexity, which is derived from how compressible the data are; (ii) amplitude coalition entropy, which measures the variability in the constitution of the set of active channels; and (iii) the novel synchrony coalition entropy (SCE), which measures the variability in the constitution of the set of synchronous channels. After some simulations on Kuramoto oscillator models which demonstrate that these measures capture distinct ‘flavours’ of complexity, we show that there is a robustly measurable decrease in the complexity of spontaneous EEG during general anaesthesia

Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment

BACKGROUND: Previously published studies have reported that up to 43% of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state (VS). However, no recent studies have investigated the accuracy of this grave clinical diagnosis. In this study, we compared consensus-based diagnoses of VS and MCS to those based on a well-established standardized neurobehavioral rating scale, the JFK Coma Recovery Scale-Revised (CRS-R). METHODS: We prospectively followed 103 patients (55 +/- 19 years) with mixed etiologies and compared the clinical consensus diagnosis provided by the physician on the basis of the medical staff's daily observations to diagnoses derived from CRS-R assessments performed by research staff. All patients were assigned a diagnosis of 'VS', 'MCS' or 'uncertain diagnosis.' RESULTS: Of the 44 patients diagnosed with VS based on the clinical consensus of the medical team, 18 (41%) were found to be in MCS following standardized assessment with the CRS-R. In the 41 patients with a consensus diagnosis of MCS, 4 (10%) had emerged from MCS, according to the CRS-R. We also found that the majority of patients assigned an uncertain diagnosis by clinical consensus (89%) were in MCS based on CRS-R findings. CONCLUSION: Despite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus

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