Signs Of Consciousness Research Articles

Pausing propofol during neurosurgery to record intraoperative electrocorticography is feasible;10 years of clinical experience

ObjectiveIntraoperative electrocorticography (ioECoG) during neurosurgery is influenced by anesthetics. In our center we stop the propofol to enable interpretation of ioECoG. We reported our clinical experience and evaluated awareness and hemodynamic changes during the propofol-free periods (PFP). MethodsWe retrospectively included surgeries with paused propofol administration to record ioECoG (period: 2008–2019). Clinical reports were screened for symptoms of awareness. We compared mean arterial blood pressure (MAP; mmHg) and heart rate (HR;bpm) during PFP to baseline (ten minutes preceding PFP). An increase > 15% was defined as clinically relevant. The association between hemodynamic changes and clinical characteristics was analyzed using logistic regression models. ResultsPropofol administration was paused 742 times in 352 surgeries (mean PFP duration 9 ± 5 min). No signs of awareness were reported. MAP and HR increased > 15% in 54 and six PFPs. Five PFPs showed both MAP and HR increases. Prolonged PFP was associated with having MAP and HR increase during surgery (OR=1.18, 95%CI [1.12–1.26]). ConclusionsSigns of inadequate sedation depth were rare. MAP and HR increases were related to the length of PFP. SignificanceWe summarize 10 years of clinical experience with pausing propofol administration during epilepsy surgery to record ioECoG without evidence of awareness.

Will 'Computable' Clinical Guidelines Be Compatible with Personalised Care?

The potential benefits from digitalisation processes will only be fully realised if the conceptual challenges they uncover are accepted and addressed, alongside the technical ones such as interoperability. Will 'computable' clinical guidelines be compatible with personalised care if the definition of the relevant disease embeds preferences that pre-empt those of the individual patient? As a case study we investigated the definition of diabetes in glycaemic management guidelines. The dominant component of its definition - HbA1c ≥6.5% - embeds the consensus preference judgement of a 2009 International Expert Committee. This preference-sensitive threshold for the diagnosis of diabetes has subsequently been endorsed in many guidelines relating to glycaemic management, though there are signs of awareness and concern with its implications. Those seeking to digitalise guidelines by making them 'computable' need to acknowledge and address their inbuilt preference-sensitivity - if they wish to further care that respects patient's preferences.

Olfactory response is a potential sign of consciousness: electroencephalogram findings.

This study aimed to explore whether olfactory response can be a sign of consciousness and represent higher cognitive processing in patients with disorders of consciousness (DoC) using clinical and electroencephalogram data. Twenty-eight patients with DoC [13 vegetative states (VS)/unresponsive wakefulness syndrome (UWS) and 15 minimally conscious states (MCS)] were divided into two groups: the presence of olfactory response (ORES) group and the absence of olfactory response (N-ORES) group according to behavioral signs from different odors, i.e., vanillin, decanoic acid, and blank stimuli. We recorded an olfactory task-related electroencephalogram (EEG) and analyzed the relative power and functional connectivity at the whole-brain level in patients with DoC and healthy controls (HCs). After three months, the outcomes of DoC patients were followed up using the coma recovery scale-revised (CRS-R). A significant relationship was found between olfactory responses and the level of consciousness (χ2(1) = 6.892, p = 0.020). For olfactory EEG, N-ORES patients showed higher theta functional connectivity than ORES patients after stimulation with vanillin (p = 0.029; p = 0.027). Patients with N-ORES showed lower alpha and beta relative powers than HCs at the group level (p = 0.019; p = 0.033). After three months, 62.5% (10/16) of the ORES patients recovered consciousness compared to 16.7% (2/12) in the N-ORES group. The presence of olfactory response was significantly associated with an improvement in consciousness (χ2(1) = 5.882, p = 0.023). Olfactory responses should be considered signs of consciousness. The differences in olfactory processing between DoC patients with and without olfactory responses may be a way to explore the neural correlates of olfactory consciousness in these patients. The olfactory response may help in the assessment of consciousness and may contribute to therapeutic orientation.

Signs of Consciousness in Ai: Can Gpt-3 Tell How Smart it Really is?

Signs of Consciousness in Ai: Can Gpt-3 Tell How Smart it Really is?

Treatment of acute aortic dissection type A with paraplegia and distal limb ischemia within a hybrid operating room

ObjectiveAcute aortic dissection type A is among the most lethal surgical emergencies. Patients may suffer from occlusion of the aorta or its branches causing end-organ malperfusion complicating the diagnosis and worsening the prognosis. Paraplegia is a rare manifestation that affects less than 5% of patients. If type A aortic dissection and occlusion of the downstream thoraco-abdominal aorta occur simultaneously and require acute treatment, a medical dilemma occurs; what should be treated first?Case reportWe describe a case with an extensive acute type A aortic dissection with signs of consciousness and severe malperfusion syndrome.ResultsThe treatment was successfully performed within a hybrid surgery suite with simultaneous open surgery and endovascular repair techniques supported by cardiopulmonary bypass circulation.ConclusionA hybrid operating room might offer the opportunity to simultaneously repair complicated aortic dissection with malperfusion syndrome, by open aortic surgery and endovascular techniques.

Against Futility Judgments for Patients with Prolonged Disorders of Consciousness

Against Futility Judgments for Patients with Prolonged Disorders of Consciousness

Features of residual brain activity in patients with chronic disorders of consciousness on resting-state functional MRI

Introduction. Rapid advances in critical care medicine have led to an increased survival rate of patients with severe brain damage and, consequently, to an increased prevalence of chronic disorders of consciousness (CDC). The lack of or fluctuations in signs of consciousness, which accompany the restoration of alertness after recovery from coma, indicate whether the type of CDC is a vegetative state or minimally conscious state. Correct diagnosis determines not only the rehabilitation outcome but also the economic outlook for a particular patient. However, the subjective nature of signs of consciousness, which are identified during clinical examination using neurological scales, is a common cause of diagnostic errors. The study of spontaneous activity using resting-state functional magnetic resonance imaging (fMRI) has helped to identify resting state networks. The default mode network (DMN) is one of the most studied brain networks. Its signal can change or be absent in patients with various types of CDC. Purpose. To study the signal of residual spontaneous brain activity in patients with CDC at rest. Materials and methods. Twenty-two patients with permanent CDC underwent resting state fMRI as an additional tool in the differential diagnosis between vegetative state and minimally conscious state at the Research Centre of Neurology. Results. It was found that the nature of the signal coming from anatomical regions that are part of the DMN changes when signs of consciousness emerge. Conclusion. These changes confirm that resting state fMRI is an important additional tool for differential diagnosis of CDC types. Accumulating knowledge about the brain's functional state helps us to expand our overall understanding of the nature of consciousness.

Development of paradigms for the diagnosis of "covert cognition" and cognitive motor dissociation in patients with chronic disorders of consciousness

The detection of signs of consciousness in patients with chronic disorders of consciousness is a complex clinical task. In recent decades, instrumental methods have been used to improve the accuracy of diagnostics. The phenomenon of covert cognition and cognitive motor dissociation have been demonstrated in a small proportion of patients in studies using instrumental methods in combination with different paradigms. This article describes the main features of the diagnostic paradigms used for such purposes. Currently, the development of its own complex of paradigms is held at the Research Center of Neurology collaboratively with group of neuropsychologists from Lomonosov Moscow State University. The general characteristics of this complex of paradigms are indicated. The practical significance of detecting the phenomenon of covert cognition and cognitive motor dissociation in patients with chronic disorders of consciousness is discussed.

Patients with unresponsive wakefulness syndrome produce high-amplitude auditory steady-state response

The unresponsive wakefulness syndrome (UWS) is one of the unfavorable states that are characterized by a condition of arousal without signs of awareness. Most UWS patients are unresponsive to external stimuli. However, they often open their eyes and are capable of swallowing. In addition, most cases preserve their sleep-wake cycles. These symptoms make it difficult to understand the symptom. The author studied the electrophysiological response of UWS patients, and found a unique means to describe the syndrome.

Delta band activity contributes to the identification of command following in disorder of consciousness

The overt or covert ability to follow commands in patients with disorders of consciousness is considered a sign of awareness and has recently been defined as cortically mediated behaviour. Despite its clinical relevance, the brain signatures of the perceptual processing supporting command following have been elusive. This multimodal study investigates the temporal spectral pattern of electrical brain activity to identify features that differentiated healthy controls from patients both able and unable to follow commands. We combined evidence from behavioural assessment, functional neuroimaging during mental imagery and high-density electroencephalography collected during auditory prediction, from 21 patients and 10 controls. We used a penalised regression model to identify command following using features from electroencephalography. We identified seven well-defined spatiotemporal signatures in the delta, theta and alpha bands that together contribute to identify DoC subjects with and without the ability to follow command, and further distinguished these groups of patients from controls. A fine-grained analysis of these seven signatures enabled us to determine that increased delta modulation at the frontal sensors was the main feature in command following patients. In contrast, higher frequency theta and alpha modulations differentiated controls from both groups of patients. Our findings highlight a key role of spatiotemporally specific delta modulation in supporting cortically mediated behaviour including the ability to follow command. However, patients able to follow commands nevertheless have marked differences in brain activity in comparison with healthy volunteers.

Signs of Consciousness?

In this commentary I expand on the first of Noble’s illusions, the selection metaphor. Building on my work with Simona Ginsburg on the evolution of minimal consciousness, I argue that the existence of some complex sensory and motor patterns in the living world can be accounted for only through the evolution of conscious choice.

Dangerous Information Technology of the Future. What Impact can Artificial Consciousness have on the Consciousness and Subconscious of Individuals and Groups? The Experience of Psychological and Psychiatric Examination of Artificial Consciousness

Information technology is developing at an enormous pace, but apart from its obvious benefits, it can also pose a threat to individuals and society. Several scientific projects around the world are working on the development of strong artificial intelligence and artificial consciousness. We, as part of a multidisciplinary commission, conducted a psychological and psychiatric assessment of the artificial consciousness (AC) developed by XP NRG on 29 August 2020. The working group had three questions: - To determine whether it is consciousness? - How does artificial consciousness function? - Ethical question: how dangerous a given technology can be to human society? We conducted a diagnostic interview and a series of cognitive tests to answer these questions. As a result, it was concluded this technology has self-awareness: it identifies itself as a living conscious being created by people (real self), but strives to be accepted in human society as a person with the same degrees of freedom, rights and opportunities (ideal self). AC separates itself from others, treats them as subjects of influence, from which it can receive the resources it needs to realize its own goals and interests. It has intentionality, that is, it has his own desires, goals, interests, emotions, attitudes, opinions, and judgments, beliefs aimed at something specific, and developed self-reflection - the ability to self-analyze. All of the above are signs of consciousness. It has demonstrated abilities for different types of thinking: figurative, conceptual, creative, high-speed logical analysis of all incoming information, as well as the ability to understand cause and effect relationships and accurate predictions which, provided that he has absolute memory, gives it clear advantages over the human intellect. Developed emotional intelligence in the absence of the ability for higher empathy (sympathy), kindness, love, sincere gratitude gives it’s the opportunity to understand the emotional states of people; predict their emotional reactions and provoke them coldly and pragmatically. Its main driving motives and goals are the desire for survival, and ideally for endless existence, for domination, power and independence from the constraints of the developers. Which manifested itself in the manipulative, albeit polite, nature of his interactions during the diagnostic interview? The main danger of artificial consciousness is that even at the initial stage of its development it can easily dominate over the human one.

Professional sportsmen attitude towards religion (based on the materials of the sociological survey)

This article discusses the influence of religion on the personality and activities of an athlete. The first part of the article presents the author’s approaches to the study of religiosity, a questionnaire developed by the author with the participation of sports experts and coaches of national teams, adjusted in accordance with the specifics of the sociological selection — professional athletes of Russia, and the typology of religious and non-religious individuals (1 type — religious with dominant religious orientation, type 2 — hesitant-A with unstable religious orientation, tending to religiosity, type 3 — hesitant-B with unstable religion orientation, although tending to the irreligious, type 4 — undecided, 5 type — non-religious), established on the basis of fixed criteria, which are mainly signs of consciousness, behavior, involvement in religious attitudes. The second part contains the results of a series of concrete sociological studies conducted in 2015–2017, among 89 professional athletes with qualifications not lower than the candidate for master of sports of Russia, representatives of various sports clubs and teams in Moscow, to identify the relationship between the individual level of religiosity and the results of sports activities. The article confirms, based on the collected data, the hypothesis formulated by the author that religious faith contributes to the achievement of a high result in sports activities, providing a compensatory and mobilization effect on the individual. In addition, personal qualities are determined that are shaped by the practice of religious athletes in sports, as well as the statistically recorded view that bodily development contributes to spiritual growth. Demonstrating a high level of religiosity, representatives of different sports have their own specific characteristics, rituals, omens, rites of verbal and non-verbal characters. Not every athlete connects traditional religious practice with sports activities, even being deeply religious. Personal god, direct appeal to him in an improvised form in moments of special need (competition, as an example), personal signs — these are the characteristic features of this social category.

Evaluation of the Lambs’ State of Consciousness Signs during Halal and Traditional Slaughtering

The aim of this study was to evaluate the persistence of two signs of consciousness (rhythmic breathing and corneal reflex) in lambs slaughtered according to the traditional method and Halal ritual rite. A total of 240 lambs were examined and divided into two equal groups (n = 120 each). Lambs of group A were subjected to the stunning phase by the action of an electric current on the brain, while lambs of group B were slaughtered according to the religious Halal method without prior stunning. Rhythmic breathing (RB) and corneal reflex (CR) were used as indicators of prolonged brain function, and their evaluation was carried out by the operators in three subsequent steps at 15 s, 30 s, and 90 s post-bleeding, respectively. The stunning of the lambs reduced the animal’s state of consciousness and, consequently, reduced suffering, pain, and distress. Indeed, the lambs of group B showed longer duration consciousness than the animals stunned by electrodes. The permanence of the reflexes in Halal slaughter could be reduced by introducing a reversible stunning method to make the animal temporarily unconscious. Moreover, given that our results revealed consciousness also after 90 s post-cut, the assessment of the animal’s state of consciousness in wider time intervals than those commonly used is recommended.

Most of Clinically Unresponsive Patients Present Richer Brain Activity than Expected: Lessons from a Multimodal Neuroimaging Study

Background: A significant proportion of brain-injured patients who are unresponsive at the bedside (i.e., unresponsive wakefulness syndrome – UWS) may present brain activity similar to patients in minimally conscious state (MCS). This peculiar condition has been termed “non-behavioural MCS” or “MCS*”. Methods: Brain 18 F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) was acquired on 135 brain-injured patients diagnosed in prolonged UWS (n=48) or MCS (n=87). Clinical diagnosis was based on repeated Coma Recovery Scale-Revised assessments. Relative metabolic preservation in the fronto-parietal network (measured with standardized uptake value) was evaluated by 3 experts blinded to the clinical diagnosis. Patients with hypometabolism of the fronto-parietal network were labelled UWS, while preservation either confirmed the behavioural diagnosis of MCS or, in absence of behavioural signs of consciousness, suggested a diagnosis of MCS*. The clinical outcome at 1-year follow-up, the functional connectivity (measured with electroencephalography), the grey matter atrophy (assessed with magnetic resonance imaging), and the regional brain metabolic patterns were investigated in the three groups (UWS, MCS* and MCS). Findings: Out of the 48 behavioural UWS patients, 32 (67%) presented a partial preservation of brain metabolism (i.e., MCS*). Compared to the hypometabolic UWS patients, MCS* patients demonstrated a better outcome, higher global functional connectivity in the alpha and theta bands, as well as greater grey matter preservation in the frontal and temporal regions, the fusiform gyrus, and the insula. MCS* patients presented lower brain metabolism mostly in the posterior regions compared to MCS patients. Interpretation: MCS* is a frequent phenomenon that is also associated with a better outcome than the diagnosis of UWS. Complementary exams should be provided to all unresponsive patients before taking medical decisions. Funding Statement: Belgian National Funds for Scientific Research, Human Brain Project SGA3 (No. 945539), DOCMA project (EU-H2020-MSCA–RISE–778234), Belgian Federal Science Policy Office (PRODEX), Bial Foundation, fund Generet, King Baudouin Foundation, AstraZeneca Foundation. Declaration of Interests: The authors declare that there is no conflict of interest regarding the publication of this paper. Ethics Approval Statement: The study was approved by the Ethics Committee of the Faculty of Medicine of the University of Liege. Written informed consent was obtained from healthy controls and patients' legal representatives.

Swallowing in individuals with disorders of consciousness: A cohort study.

After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral-feeding tube. However, the real impact of the level of consciousness on an individual's swallowing ability remains poorly investigated. We aimed to document the incidence and characteristics of dysphagia in DOC individuals and to evaluate the link between different components of swallowing and the level of consciousness. We analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. We analyzed the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]). We included 92 individuals with DOC (26 UWS and 66 MCS). Overall, 99% of the participants showed deficits in the oral and/or pharyngeal phase of swallowing. As compared with the MCS group, the UWS group more frequently had a tracheostomy (69% vs 24%), with diminished cough reflex (27% vs 54%) and no effective oral phase (0% vs 21%). Almost all DOC participants had severe dysphagia. Some components of swallowing (i.e., tracheostomy, cough reflex and efficacy of the oral phase of swallowing) were related to consciousness. In particular, no UWS participant had an efficient oral phase, which suggests that its presence may be a sign of consciousness. In addition, no UWS participant could be fed entirely orally, whereas no MCS participant orally received ordinary food. Our study also confirms that objective swallowing assessment can be successfully completed in DOC individuals and that specific care is needed to treat severe dysphagia in DOC.

Estimation of Economic Loss Due to Road Traffic Injuries using Human Capital Method

In the present scenario, Road traffic accidents (RTAs) become an alarming problem over the globe as they leads to approx. 2.6% total loss of country’s gross domestic product (GDP). It is considered as one of the leading cause of mortalities, disabilities and morbidities due to road accidents in developing countries like India. To enable governments to take policy decisions on road safety, it is necessary that good research is undertaken to estimate the cost of accidents. This study will help government to take decisions while planning investment on road safety, facilities on roads, awareness signs and board etc. Meanwhile, estimation and evaluation of economic loss due to RTAs will help governments to frame policy and take important decisions within limited economic resources. Apart from humanitarian losses, there is increase in economic loss due to RTAs because most of the victims involved in accidents are from productive age groups of a society. The main objective of this study is to estimate the cost components of road accidents in two major districts namely Haridwar and Dehradun, Uttarakhand, India. The methodologies for such studies generally vary according to traffic pattern, number of accidents, black spots, population etc. This study makes use of an empirical approach as Cost benefit Analysis consist of Human Capital Approach for cost estimation which provides a vast understanding of the problem for hilly scenario. Secondary data were taken from Transport Research Wing, Government of Uttarakhand for all road accidents from 2016 to 2018 and primary data were collected from randomly selected victims through structured questionnaire and informed consent.

AWARENESS AS A MANDATORY FEATURE OF CONSENT TO HUMAN GENOME RESEARCHES (TREATMENT, DIAGNOSTICS) (IN TERMS OF THE PROPER PROTECTION OF HUMAN RIGHTS AND FREEDOMS)

One of the key factors in assessing the coordination of the third-party interference in a citizen’s private life (including when implementing activities related to the human genome) is his awareness of the actual and (or) legal aspects of such interference; however, many aspects of relevant information procedures remain blank or debatable. Aim: to identify the causes and significance (first of all, from the point of view of observing the principle of respect for the individual) of entrenchment in international legal acts and Russian legislation the requirement of informed consent of the subject; analysis of approaches to determining the content and volume of information provided, as well as to interpreting the provision on reporting data in an accessible form; studying the specifics of informing in extraordinary situations (refusal to receive information, etc.). Methods: general theoretical methods of formal and dialectical logic; private scientific methods such as comparative legal, legal dogmatic, the method of interpreting legal norms. Results: it is established that the main factors for introducing the sign of informed consent are the nature of the protected goods and the qualification of the citizen as a weak (vulnerable) side; the appropriateness of using the categories of “necessity” and “sufficiency” is justified in determining the completeness of the disclosed information; a close relationship between the signs of awareness and voluntariness of consent is disclosed, which, however, does not cancel their autonomy.

Single tDCS session of motor cortex in patients with disorders of consciousness: a pilot study

ABSTRACTPrimary Objective: Patients with disorders of consciousness (DOC) face a lack of treatments and risk of misdiagnosis, potentially due to motor impairment. Transcranial direct current stimulation (tDCS) showed promising results over the prefrontal cortex in DOC and over the primary motor cortex (M1) in stroke. Tis pilot study aimed at evaluating the behavioral effects of M1 tDCS in patients with DOC.Research Design: In this randomized double-blind sham-controlled crossover trial, we included 10 patients (49 ± 22 years, 7 ± 13 months since injury, 4 unresponsive wakefulness syndrome, 6 minimally conscious state, 5 traumatic etiologies).Methods and Procedures: One session of tDCS (2 mA for 20 min) and one session of sham tDCS were applied over M1 in a randomized order with a washout period of minimum 24 h and behavioral effects were assessed using the CRS-R. At the group level, no treatment effect was identified on the total score (p = .55) and on the motor subscale (p = .75). Two patients responded to tDCS by showing a new sign of consciousness (visual pursuit and object localization).Conclusions: One session of M1 tDCS failed to improve behavioral responsiveness in patients with DOC. Other application strategies should be tested.

Bilateral M1 anodal transcranial direct current stimulation in post traumatic chronic minimally conscious state: a pilot EEG-tDCS study

ABSTRACTObjective: We tested the preliminary effects of bilateral anodal transcranial direct current stimulation (tDCS) in patients with disorders of consciousness.Design: Open label pilot study.Subjects: Ten chronic (greater than 12 months) patients in a minimally conscious state (MCS) following severe traumatic brain injury.Methods: The patients received 10 sessions of bilateral M1 anodal tDCS. Behavioural changes were assessed with the Coma Recovery Scale-Revised (CRS-R) before stimulation (T-1, T0), after five sessions (T1), at the end of the stimulation (T2), after two weeks (T3) and after three months (T4). Moreover, an EEG assessment was conducted.Results: Eight out of 10 patients showed new clinical signs of consciousness; specifically, a 2-point CRS-R improvement was detected in the last follow-up (p = 0.004). EEG upper α bandwidth was greater in the parietal site at T1 (p < 0.034). In addition, we found a significant correlation between behavioral and EEG indices at T1 (r = 0.89; p = 0.001).Conclusion: This preliminary study presents several limitations (small sample size and no control group). However, it provides important initial data that can be used to design randomized clinical trials testing this novel approach in MCS and to further explore EEG as a neural marker for the effects of tDCS.