Theoretically, consciousness depends on the brain\u2019s ability to engage in complex activity patterns that are, at once, distributed among interacting cortical areas (integrated) and differentiated in space and time (information-rich). In a recent series of experiments the electroencephalographic response to a direct cortical stimulation in humans was recorded during wakefulness and non-rapid eyes movement sleep (NREM) by means of a combination of transcranial magnetic stimulation (TMS) and high-density electroencephalogram (hd-EEG). TMS/hd-EEG measurements showed that, while during wakefulness the brain is able to sustain long-range specific patterns of activation, during NREM sleep, when consciousness fades, this ability is lost: the thalamocortical system, despite being active and reactive, either breaks down in causally independent modules (producing a local slow wave), or it bursts into an explosive and non-specific response (producing a global EEG slow wave). We hypothesize that, like spontaneous sleep slow waves, the slow waves triggered by TMS during deep sleep are due to bistability between periods of hyperpolarized down-state in cortical neurons, and periods of activation (up-state). In this condition, the inescapable occurrence of a silent, down-state after an initial activation could impair the ability of thalamocortical circuits to sustain long-range, differentiated patterns of activation, a theoretical requisite for consciousness. According to animal experiments the extracellular signature of the downstate is a transient suppression of high frequency (20Hz) oscillations \u2013 that is followed by a loss of both PLF and PLV, in spite of restored levels of neuronal activity. These results point to bistability as the underlying critical mechanism that prevents the emergence of complex interactions in human thalamocortical networks when consciousness is lost during NREM sleep. This finding is particularly relevant because a similar mechanism may play a role in other conditions where loss of consciousness is paralleled by the appearance of spontaneous (or TMS evoked) slow waves such as some kind of anesthesia and in brain injured subjects
