The influence of mild traumatic brain injury on attentional Bias: Preliminary evidence.

Why do we sleepwalk? A noradrenergic hypothesis of NREM sleep parasomnias.

EEG reactivity (EEG-R) is currently classified as present, absent, or stimulus-induced rhythmic, periodic, or ictal discharges, per the American Clinical Neurophysiology Society's 2021 Critical Care EEG Terminology. However, our previous study suggested that there may be other forms of EEG-R that warrant distinction, potentially associated with different comorbidities and outcomes. We, therefore, aimed to define "typical" vs "atypical" EEG-R, referring to increased power of arrhythmic alpha/beta frequencies vs delta frequencies after stimulation, respectively, and to identify their associated comorbidities and outcomes. This was a retrospective single-center study, examining adult patients admitted between 2015 and 2022, who underwent continuous EEG (cEEG) as standard-of-care work-up for their illnesses. Univariate testing and logistic regression were performed. The primary patient outcome at hospital discharge was categorized by the modified Rankin Scale (0-2: good; 3-6: poor). The primary independent variable was the presence of typical vs atypical EEG-R. Additional covariates included age, presence of critical illness, and acute intracranial and nonintracranial pathologies. A total of 238 patients with typical EEG-R (median age 54 years, female 50%) and 322 with atypical EEG-R (median age 60 years, female 50%) were identified. Patients with typical EEG-R more commonly underwent cEEG for spell capture of non-neurological episodes (20% vs 0%, Δ20%, 95% CI 15-25, p < 0.0001) or primary seizures (13% vs 2%, Δ11%, 95% CI 7-16, p < 0.0001). Patients with atypical EEG-R were more critically ill (88% vs 32%, Δ56%, 95% CI 49-63, p < 0.0001) with more intracranial (69% vs 45%, Δ24%, 95% CI 15-32, p < 0.0001) and nonintracranial pathologies (92% vs 38%, Δ54%, 95% CI 48-61, p < 0.0001) and concomitant altered mental status (47% vs 30%, Δ17%, 95% CI 9-25, p < 0.0001). These patients were hospitalized longer (median 24.0 vs 7.0 days, Hodges-Lehmann estimator 14 days, 95% CI 12-17, p < 0.0001) with higher rates of poor outcomes (74% vs 22%, Δ52%, 95% CI 45-59, p < 0.0001). In the logistic regression model, the inverse association between atypical EEG-R and good outcome remained significant after adjusting for other covariates (odds ratio 0.20, 95% CI 0.11-0.34, p < 0.0001). Granular, frequency-based assessments of EEG-R, such as the differentiation between typical vs atypical EEG-R, may provide further insight into the potential outcomes of patients with altered states of consciousness. Limitations of this study include the single-center retrospective nature.

ABSTRACTBackgroundRespiratory variability (RV) reflects the dynamic modulation of breathing patterns by the central nervous system and may serve as a physiological marker of consciousness. However, its predictive value in disorders of consciousness (DOC) remains unclear.ObjectiveTo investigate the relationship between RV and the level of consciousness, and to evaluate the potential of RV‐based analysis for predicting clinical outcomes in DOC patients.MethodsPatients with disorders of consciousness and healthy controls were assessed using inertial measurement unit (IMU) sensors to record triaxial acceleration signals. RV indicators were extracted from respiratory waveforms. A generalized additive model (GAM) was applied to adjust for confounding variables. Group differences were evaluated using Bootstrap resampling and the Mann–Whitney U test. Machine learning models—including random forest, elastic net, support vector machine, and partial least squares regression—were employed to predict Coma Recovery Scale–Revised (CRS‐R) scores and clinical outcomes.ResultsSignificant differences in multiple RV indicators were observed between patient and control groups (p < 0.05), indicating an association between RV and the pathophysiology of consciousness disorders. Among the tested models, the random forest algorithm achieved the best predictive performance for CRS‐R scores (mean squared error = 3.76, R2 = 0.76) and for clinical outcomes (AUC = 0.74, sensitivity = 0.86), outperforming other models.ConclusionsRespiratory variability, particularly when analyzed via random forest modeling, shows strong potential for prognostic assessment and clinical decision support in disorders of consciousness. RV may represent a non‐invasive biomarker reflecting the neural control of respiration and consciousness state.

Sedation during mechanical ventilation is common in intensive care units (ICUs). Functional near-infrared spectroscopy (fNIRS) has shown potential in monitoring brain function. This study aimed to evaluate and compare the brain functional connectivity (FC) characteristics in different sedated patients using fNIRS. Thirty sedated patients in the ICU and 16 conscious, non-sedated patients from the emergency ward were enrolled. Sedated patients were assigned to insufficient sedation (+ 1 to + 4), light sedation (-2 to 0), or deep sedation (-5 to -3) groups based on the Richmond Agitation Sedation Scale. Six-minute resting-state light intensity signals were collected using fNIRS and converted into a time series of relative oxyhemoglobin concentrations. FC characteristics of the overall brain and six regions of interest (ROIs) were compared using Pearson's correlation coefficients calculation. Multiple comparisons were corrected using the False Discovery Rate method. The deep sedation group had the highest overall mean FC compared with the other groups, which may be associated with the alterations of sedatives on cortical activity. ROI-level analyses revealed higher FC in the prefrontal, parietal, and occipital cortices in the deep sedation group than in the other groups. The deep sedation group had higher channel-channel and ROI-ROI FC in the FC matrices than the other groups. ROI-ROI connections differences were observed between the deep sedation and insufficient sedation groups. No significant difference in FC was identified between the light sedation group and the conscious control group. Deep sedation exhibited the highest overall and regional FC, and light sedation and the conscious state had similar FC patterns, supporting the potential utility of fNIRS for sedation monitoring in the ICU setting.Trial registration: ChiCTR2300068437 registration May 15, 2023, https://clinicaltrials.gov/ct2/show/ChiCTR2300068437.

Functional connectivity disruptions and topological structure alterations centered around the sensorimotor network in disorders of consciousness: a functional near-infrared spectroscopy study.

Objective This study aimed to investigate the effect of high-frequency transcranial magnetic stimulation (TMS) targeting multiple brain regions on the recovery of consciousness in patients with minimally conscious state (MCS). Methods A retrospective analysis was conducted on MCS patients between August 2022 and March 2024. Some patients received only conventional rehabilitation treatment, while others received additional TMS therapy. Clinical outcomes were assessed using the Glasgow Coma Scale (GCS) and the Coma Recovery Scale-Revised (CRS-R) at three time points: before treatment (T0), two weeks post-treatment (T1), and one month post-treatment (T2). Additional assessments included electroencephalogram (EEG), brainstem auditory evoked potential (BAEP), somatosensory evoked potentials (SEP), and serum levels of brain-derived neurotrophic factor (BDNF) and neuron-specific enolase (NSE). Results A total of 30 patients were included and divided equally into two groups. The GCS and CRS-R scores of the 15 patients who received TMS therapy demonstrated significant improvements at T1 and T2. Furthermore, these patients exhibited significant enhancements in EEG and BAEP grading at T1. Conclusion The findings suggest that adjunctive multi-target high-frequency repetitive TMS may promote recovery of consciousness in MCS patients. These results underscore the potential of repetitive TMS as a therapeutic intervention for MCS and warrant further investigation in future studies.

Diagnostic uncertainty is a major barrier to the timely treatment of heart failure (HF) in the prehospital setting. We aimed to develop and validate a decision support tool using readily available clinical variables to predict the probability of HF among dyspnoeic patients transported by emergency medical services (EMS). A population-based cohort of all adults transported by EMS for dyspnoea in Victoria, Australia was chronologically split into derivation (2015-2017) and temporal validation (2018-2019) cohorts. Two models were developed: (1) a full multivariable logistic regression model using adaptive least absolute shrinkage and selection operator regression, and (2) a simplified points-based RAPID-CHF score derived from the nine most predictive variables. Among 271,204 patients with dyspnoea (176,269 derivation; 94,935 validation), 9.4% and 9.0% had HF, respectively. The full model included 19 variables and demonstrated excellent discrimination (AUC 0.861 derivation; 0.862 validation) and calibration. The RAPID-CHF score (range 0-13; comprising age, ECG rhythm, prior HF, conscious state, oxygen saturation, blood pressure, temperature, peripheral oedema, and crackles) retained strong performance (AUC 0.835 derivation; 0.836 validation) and calibration. HF prevalence increased across predefined risk categories: low (score 0-5; HF prevalence 1.7%), moderate (6-9; 13.6%) and high (10-13; 46.4%). Decision curve analysis demonstrated greater net benefit across clinically relevant thresholds than current EMS diagnosis or "treat all"/"treat none" strategies. A risk score derived from routinely collected prehospital variables accurately estimates HF probability among EMS-transported patients with dyspnoea. The RAPID-CHF score may facilitate earlier diagnosis and timely initiation of HF therapy in EMS workflows.

Diverging results with converging operations: Implications for the study of consciousness and cognition.

Ketamine-induced changes in accumbal glutamate and their association with altered states of consciousness.

Consciousness is central to the human condition, but its inherent characteristics and underlying mechanisms remain poorly understood. Advances in neuroscience based on the concept of the vegetative state have expanded the understanding of disorders of consciousness (DoC), particularly the minimally conscious state (MCS) and emergence from the MCS. Despite this progress, diagnostic uncertainty persists due to the subtlety of clinical signs and variable outcomes. Although standardized behavioral scales remain the gold standard for diagnosing DoC, advanced imaging and electrophysiological tools increasingly highlight the importance of multimodal assessments. These approaches have demonstrated that patients who appear unresponsive in behavioral assessments may voluntarily engage in mental activities that can be detected using functional magnetic resonance imaging and electroencephalography, potentially revealing covert consciousness and suggesting possible therapeutic strategies. This review consolidates the current evidence on the diagnosis, prognosis, and mechanisms of DoC across various neurological conditions. We highlight the role of brain networks in producing diverse phenotypes as well as the need for well-designed studies that can improve multimodal diagnostic strategies. Building on recent initiatives aimed at standardizing definitions, prognostic guidelines, data collection, and clinical management practices, we show that further multimodal neuroimaging research is essential to improving diagnoses, prognostication, and outcomes for patients with DoC and their families.

Based on its in vitro profile and preliminary evidence, 4-bromo-2,5-dimethoxyphenethylamine (2C-B) may have psychoactive properties that are similar to 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin, which are investigated for the treatment of posttraumatic stress disorder and depressive disorders. We compared acute effects of 2C-B (10, 20, and 30 mg), 125 mg MDMA, and 25 mg psilocybin in 24 healthy participants (12 women, 12 men) using a double-blind, randomized, placebo-controlled, crossover design. Outcome measures included acute subjective effects, autonomic effects, adverse effects, effects on emotional and cognitive empathy, plasma oxytocin and neurophysin I concentrations, and pharmacokinetics up to 9 h. 2C-B produced dose-dependent subjective effects, with the 30 mg dose exerting comparable "any drug effects" to MDMA but lower "any drug effects" than psilocybin. Only psilocybin induced "bad drug effects" and "anxiety" compared with placebo. The 30 mg dose of 2C-B induced psychedelic-type alterations of state of consciousness and increased emotional empathy similarly to MDMA. The average subjective effect duration of 30 mg 2C-B was 4.9 h and similar to MDMA (4.8 h) and shorter than psilocybin (6.1 h). MDMA produced the highest cardiovascular stimulation, followed by psilocybin and 2C-B. Only MDMA increased plasma oxytocin and neurophysin I concentrations. 2C-B exhibited dose-proportional pharmacokinetics, with a plasma elimination half-life of ~1.3 h. The 30 mg dose of 2C-B induced entactogenic and psychedelic effects similarly to MDMA and psilocybin, respectively. MDMA is more cardiostimulant than psilocybin and 2C-B. At the tested dose-level, psilocybin is more distressing than MDMA and 2C-B. These results may assist with dose-finding for future 2C-B research and provide a direct comparison with standard doses of the prototypical compounds MDMA and psilocybin. Trial registration: ClinicalTrials.gov identifier: NCT05523401.

Brain-body integromics of the ayahuasca experience.

Transpersonal psychology has contributed significantly to the understanding of spiritual emergence and crisis by legitimizing non-ordinary states of consciousness and anomalous experiences. However, many prevailing frameworks continue to rely on intrapsychic explanatory models that lack clear evidential thresholds when confronted with experiences that appear to involve autonomous or external agency. This paper proposes a critical-evidential transpersonal framework that integrates phenomenological insight with empirical standards drawn from parapsychological research. Central to this framework is the construct of Direct Spiritual Intelligent Intrusion (DSII), introduced as a provisional model for investigating spiritual crises that present with convergent subjective and objective indicators not readily accounted for by internal psychological processes alone. Using established transpersonal approaches and contemporary narrative-based therapies as illustrative cases, this paper examines the epistemic limitations of a priori intrapsychic reductionism and argues for the necessity of differential diagnosis in the assessment of spiritual crisis. By emphasizing ontological suspension, graduated evidential assessment, and clinical humility, the framework seeks to bridge the methodological divide between transpersonal psychology and parapsychology while reducing the risk of misclassification, premature pathologization, and explanatory closure.

Renewal of research into psychedelics indicates their ability to provide relief from challenging conditions like trauma, treatment resistant depression, addictions, and end-of-life distress. Psychedelics appear to promote neuroplasticity, stimulate creativity, dampen fear responses, circumvent psychological defenses, soften rigid beliefs, and foster profound feelings of unity. The non-verbal, non-linear, and experiential nature of art therapy makes it well matched for psychedelic assisted therapy (PAT), providing a way to externalize and engage with the ineffable qualities of Non-Ordinary States of Consciousness (NOSC). This article presents a psychedelic art therapy approach that weaves art therapy principles and interventions into the preparation, dosing, and integration phases of PAT. Recommendations for research are presented, along with training competencies and ethical considerations unique to this work.

BACKGROUND: Glutamatergic neurons in the medial septum (MS) are identified to promote emergence from sevoflurane general anesthesia (GA), with the potential downstream neural circuit remaining to be explored. METHODS: Rabies virus (RV)-mediated monosynaptic retrograde tracing and anterograde tracing were first used to identify the projection from glutamatergic MS neurons (MS Glu ) to glutamatergic neurons in the lateral hypothalamus (LH, LH Glu ). In vivo fiber photometry, optogenetic bidirectionally manipulations, electroencephalogram/electromyogram (EEG/EMG), and behavioral tests were further employed to investigate the role of the circuit from MS Glu neurons to the LH (MS Glu -LH circuit) in regulating states of consciousness under two different states of sevoflurane GA: continuous, steady-state general anesthesia (CSSGA) and burst-suppression (BS) oscillations. RESULTS: The retrogradely labeled upstream neurons of LH Glu neurons were extensively detected in the MS, and most RV-infected neurons in the MS were co-labeled by Vesicular glutamate transporter 2 (Vglut2, mean ± standard error of the mean [SEM], 86.3% ± 1.5%, n = 4 mice). And the MS Glu -LH Glu circuit constitutes the highest proportion among the three downstream LH neuronal populations (presynaptic boutons co-localized ratio: glutamatergic, 77.0% ± 2.2%; γ-aminobutyric acid-ergic, 59.6% ± 0.9%; orexinergic, 28.5% ± 2.0%; n = 4 mice). The calcium activity of the MS Glu -LH circuit was inhibited concurrently as the process of loss of consciousness during 2.4% sevoflurane induction. Optogenetic activation of the MS Glu -LH circuit promoted behavioral arousal and increased β power of EEG (stimulation vs pre-stimulation, 16.8% ± 2.3% vs 9.7% ± 1.7%, P =.0065; n = 8 mice) during CSSGA. In contrast, during CSSGA, optogenetic inhibition of the MS Glu -LH projection deepened cortical inhibition, characterized by increased δ power and decreased power of β and γ (inhibition vs pre-inhibition, δ: 62.4% ± 4.5% vs 55.3% ± 4.2%, P =.0404; β: 6.7% ± 0.8% vs 9.4% ± 1.3%, P =.0069; γ: 3.3% ± 0.6% vs 4.8% ± 0.8%, P =.0076; n = 8 mice). Optogenetic bidirectionally manipulations of the MS Glu -LH circuit induced similar effects during BS: activation of this projection resulted in cortical activation with decreased burst-suppression ratio (BSR; median [25%–75% percentiles], stim vs pre, 59.0% [43.8%–64.5%] vs 77.5% [74.0%–84.3%], P =.0121; n = 8 mice), while inhibition of this projection led to cortical inhibition with increased BSR (inhib vs pre, 76.1% ± 7.0% vs 64.5% ± 8.4%, P =.0382; n = 8 mice). CONCLUSIONS: This study reveals that activation of the glutamatergic MS-LH circuit promotes emergence from sevoflurane GA.

We present the case of a43-year-old multiparous pregnant patient at 29weeks of gestation admitted to the emergency department with altered consciousness (minimally conscious state), vomiting, and pain in the upper part of the abdomen. Ultrasound examination on admission revealed intrauterine fetal demise of amale fetus. Considering the general condition and intrauterine fetal demise, cesarean section was performed. Postoperatively, the condition of the patient required admission to the intensive care unit (ICU). Treatment included corticosteroid therapy, ursodeoxycholic acid, and correction of acoagulation disorder. Disseminated intravascular coagulopathy was excluded based on laboratory findings, which revealed liver insufficiency with impaired synthetic and excretory function as well as acute kidney injury. Screenings for hepatotropic viruses (hepatitisA, B, C; cytomegalovirus, Epstein-Barr virus, herpes simplex virus types1 and2) as well as autoimmune and metabolic liver diseases were negative. Computed tomography (CT) of the abdomen was performed, indicating acute fatty liver of pregnancy (AFLP). The diagnosis was confirmed by ultrasound-guided percutaneous liver biopsy and histopathological analysis. During further treatment, synthetic and excretory liver function recovery was achieved, along with complete improvement of renal function parameters. The patient was discharged to home care in with asatisfactory general condition and laboratory findings.

Access denied: Plato's cave and the epistemic limits of cellular life.

Autism Spectrum Disorder (ASD) is a lifelong condition marked by challenges in social communication and repetitive behaviors. Current treatments, primarily behavioral therapies, often fail to address the core symptoms. Recent research has explored the potential of psychedelics, such as LSD, psilocybin, and MDMA, as a new therapeutic approach. While these substances primarily modulate the serotonin 5-HT2A receptor, their therapeutic effects also involve interactions with other serotonergic, dopaminergic, and glutamatergic pathways, collectively promoting neuroplasticity-the brain's ability to change and adapt. The specific receptors' activation leads to structural and functional changes in the brain that can enhance social behavior and emotional regulation. Studies show that psychedelics may reduce symptoms of conditions like treatment-resistant depression and PTSD, highlighting their therapeutic potential. For ASD specifically, psychedelics may improve psychological flexibility, reduce distress, and enhance social interaction. While promising, the use of these substances requires careful consideration. Psychedelics can induce intense experiences and altered states of consciousness, necessitating strict monitoring and support during therapy. Ethical guidelines, including informed consent, are crucial, especially for vulnerable populations. In conclusion, psychedelics hold significant promise for treating ASD and other psychiatric disorders by promoting neuroplasticity and modulating complex signaling pathways. Continued research and clinical trials, conducted with strong ethical oversight, are essential to realizing their full therapeutic potential.

Accurate assessment of residual awareness in patients with Prolonged Disorders of Consciousness (PDoC) remains a major clinical challenge, as conventional behavioural tools can underestimate covert cognition. This study evaluates whether a structured, multi-phase motor imagery Brain-Computer Interface (MI-BCI) protocol provides objective electroencephalography (EEG)-based indicators of awareness that complement behavioural assessments. Forty-four participants (N = 44) completed repeated imagined-movement tasks using wearable EEG (PDoC: Unresponsive Wakefulness Syndrome (UWS, n = 14), Minimally Conscious State (MCS, n = 17), Locked-In Syndrome (LIS, n = 11); two able-bodied participants as benchmarks; ClinicalTrials.gov: NCT03827187; 30-01-2019). The protocol assessed sensorimotor rhythm modulation, training with and without neurofeedback, and binary question answering across phases. Standard behavioural assessments (CRS-R and WHIM) were administered at each session. Significant MI-BCI decoding accuracy (DA) is achieved by 73.8% of patients, of whom 90% progress to Q&A testing and frequently exceed the 70% usability threshold, revealing marked inter-individual heterogeneity. For significant MI-BCI runs, LIS outperform MCS (p = 0.007) and UWS (p = 0.048), while UWS exceed MCS during Q&A (p = 0.049), driven by familiar-voice stimuli. Using leave-one-subject-out cross-validation, combining predictions from DA and behavioural assessments improves balanced diagnostic accuracy to 62% (from 55%), increasing sensitivity to MCS (39% to 69%), with a modest reduction in LIS sensitivity (78% to 67%). Task-related activity over sensorimotor and parietal cortices differentiate diagnostic groups. The structured MI-BCI protocol demonstrates potential as a movement-independent, EEG-based tool for distinguishing UWS, MCS and LIS. Integrating DA and spatial patterns yields diagnostic information that may augment behavioural assessment and advance objective tools for evaluating awareness in PDoC.