Electroencephalogram approximate entropy influenced by both age and sleep

The use of information-based measures to assess changes in conscious state is an increasingly popular topic. Though recent results have seemed to justify the merits of such methods, little has been done to investigate the applicability of such measures to children. For our work, we used the approximate entropy (ApEn), a measure previously shown to correlate with changes in conscious state when applied to the electroencephalogram (EEG), and sought to confirm whether previously reported trends in adult ApEn values across wake and sleep were present in children. Besides validating the prior findings that ApEn decreases from wake to sleep (including wake, rapid eye movement (REM) sleep, and non-REM sleep) in adults, we found that previously reported ApEn decreases across vigilance states in adults were also present in children (ApEn trends for both age groups: wake > REM sleep > non-REM sleep). When comparing ApEn values between age groups, adults had significantly larger ApEn values than children during wakefulness. After the application of an 8 Hz high-pass filter to the EEG signal, ApEn values were recalculated. The number of electrodes with significant vigilance state effects dropped from all 109 electrodes with the original 1 Hz filter to 1 electrode with the 8 Hz filter. The number of electrodes with significant age effects dropped from 10 to 4. Our results support the notion that ApEn can reliably distinguish between vigilance states, with low-frequency sleep-related oscillations implicated as the driver of changes between vigilance states. We suggest that the observed differences between adult and child ApEn values during wake may reflect differences in connectivity between age groups, a factor which may be important in the use of EEG to measure consciousness

On the statistical assessment of small sample classification

Classifiers start to be used in medical application to infer diagnosis. Their results are assessed through either a binomial or a permutation test. Distributions built from classification of random data with cross-validation, did not follow the theoretical binomial distribution, showing that binomial test was not conservative enough. A permutation test is thus recommended.Peer reviewe

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

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

Electrophysiological investigations of brain function in coma, vegetative and minimally conscious patients.

Electroencephalographic activity in the context of disorders of consciousness is a swiss knife like tool that can evaluate different aspects of cognitive residual function, detect consciousness and provide a mean to communicate with the outside world without using muscular channels. Standard recordings in the neurological department offer a first global view of the electrogenesis of a patient and can spot abnormal epileptiform activity and therefore guide treatment. Although visual patterns have a prognosis value, they are not sufficient to provide a diagnosis between vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) patients. Quantitative electroencephalography (qEEG) processes the data and retrieves features, not visible on the raw traces, which can then be classified. Current results using qEEG show that MCS can be differentiated from VS/UWS patients at the group level. Event Related Potentials (ERP) are triggered by varying stimuli and reflect the time course of information processing related to the stimuli from low-level peripheral receptive structures to high-order associative cortices. It is hence possible to assess auditory, visual, or emotive pathways. Different stimuli elicit positive or negative components with different time signatures. The presence of these components when observed in passive paradigms is usually a sign of good prognosis but it cannot differentiate VS/UWS and MCS patients. Recently, researchers have developed active paradigms showing that the amplitude of the component is modulated when the subject's attention is focused on a task during stimulus presentation. Hence significant differences between ERPs of a patient in a passive compared to an active paradigm can be a proof of consciousness. An EEG-based brain-computer interface (BCI) can then be tested to provide the patient with a communication tool. BCIs have considerably improved the past two decades. However they are not easily adaptable to comatose patients as they can have visual or auditory impairments or different lesions affecting their EEG signal. Future progress will require large databases of resting state-EEG and ERPs experiment of patients of different etiologies. This will allow the identification of specific patterns related to the diagnostic of consciousness. Standardized procedures in the use of BCIs will also be needed to find the most suited technique for each individual patient.Peer reviewe

Modern Electrophysiological Methods for Brain-Computer Interfaces

Modern electrophysiological studies in animals show that the spectrum of neural oscillations encoding relevant information is broader than previously thought and that many diverse areas are engaged for very simple tasks. However, EEG-based brain-computer interfaces (BCI) still employ as control modality relatively slow brain rhythms or features derived from preselected frequencies and scalp locations. Here, we describe the strategy and the algorithms we have developed for the analysis of electrophysiological data and demonstrate their capacity to lead to faster accurate decisions based on linear classifiers. To illustrate this strategy, we analyzed two typical BCI tasks. (1) Mu-rhythm control of a cursor movement by a paraplegic patient. For this data, we show that although the patient received extensive training in mu-rhythm control, valuable information about movement imagination is present on the untrained high-frequency rhythms. This is the first demonstration of the importance of high-frequency rhythms in imagined limb movements. (2) Self-paced finger tapping task in three healthy subjects including the data set used in the BCI-2003 competition. We show that by selecting electrodes and frequency ranges based on their discriminative power, the classification rates can be systematically improved with respect to results published thus far

Neuroimaging after coma.

Following coma, some patients will recover wakefulness without signs of consciousness (only showing reflex movements, i.e., the vegetative state) or may show non-reflex movements but remain without functional communication (i.e., the minimally conscious state). Currently, there remains a high rate of misdiagnosis of the vegetative state (Schnakers et. al. BMC Neurol, 9:35, 8) and the clinical and electrophysiological markers of outcome from the vegetative and minimally conscious states remain unsatisfactory. This should incite clinicians to use multimodal assessment to detect objective signs of consciousness and validate para-clinical prognostic markers in these challenging patients. This review will focus on advanced magnetic resonance imaging (MRI) techniques such as magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI (fMRI studies in both "activation" and "resting state" conditions) that were recently introduced in the assessment of patients with chronic disorders of consciousness

Brain Connectivity in Pathological and Pharmacological Coma

Recent studies in patients with disorders of consciousness (DOC) tend to support the view that awareness is not related to activity in a single brain region but to thalamo-cortical connectivity in the frontoparietal network. Functional neuroimaging studies have shown preserved albeit disconnected low-level cortical activation in response to external stimulation in patients in a “vegetative state” or unresponsive wakefulness syndrome. While activation of these “primary” sensory cortices does not necessarily reflect conscious awareness, activation in higher-order associative cortices in minimally conscious state patients seems to herald some residual perceptual awareness. PET studies have identified a metabolic dysfunction in a widespread frontoparietal “global neuronal workspace” in DOC patients including the midline default mode network (“intrinsic” system) and the lateral frontoparietal cortices or “extrinsic system.” Recent studies have investigated the relation of awareness to the functional connectivity within intrinsic and extrinsic networks, and with the thalami in both pathological and pharmacological coma. In brain damaged patients, connectivity in all default network areas was found to be non-linearly correlated with the degree of clinical consciousness impairment, ranging from healthy controls and locked-in syndrome to minimally conscious, vegetative, coma, and brain dead patients. Anesthesia-induced loss of consciousness was also shown to correlate with a global decrease in cortico-cortical and thalamo-cortical connectivity in both intrinsic and extrinsic networks, but not in auditory, or visual networks. In anesthesia, unconsciousness was also associated with a loss of cross-modal interactions between networks. These results suggest that conscious awareness critically depends on the functional integrity of thalamo-cortical and cortico-cortical frontoparietal connectivity within and between “intrinsic” and “extrinsic” brain networks

Toward an attention-based diagnostic tool for patients with locked-in syndrome

Electroencephalography (EEG) has been proposed as a supplemental tool for reducing clinical misdiagnosis in severely brain-injured populations helping to distinguish conscious from unconscious patients. We studied the use of spectral entropy as a measure of focal attention in order to develop a motor-independent, portable, and objective diagnostic tool for patients with locked-in syndrome (LIS), answering the issues of accuracy and training requirement. Data from 20 healthy volunteers, 6 LIS patients, and 10 patients with a vegetative state/unresponsive wakefulness syndrome (VS/UWS) were included. Spectral entropy was computed during a gaze-independent 2-class (attention vs rest) paradigm, and compared with EEG rhythms (delta, theta, alpha, and beta) classification. Spectral entropy classification during the attention-rest paradigm showed 93% and 91% accuracy in healthy volunteers and LIS patients respectively. VS/UWS patients were at chance level. EEG rhythms classification reached a lower accuracy than spectral entropy. Resting-state EEG spectral entropy could not distinguish individual VS/UWS patients from LIS patients. The present study provides evidence that an EEG-based measure of attention could detect command-following in patients with severe motor disabilities. The entropy system could detect a response to command in all healthy subjects and LIS patients, while none of the VS/UWS patients showed a response to command using this system