Abstract
While the detection of voluntary signs at the patient’s bedside is considered sufficient to infer that the subject is conscious, their absence does not necessarily imply the absence of conscious perception. Recently, the development of new neuroimaging and electrophysiological active paradigms (where the patient has to mentally perform a task) allowed the detection of signs of consciousness in patients completely unable to move. However, in the case of a negative result, these two methods leave the question of the presence or absence of consciousness unanswered. In this chapter, we propose an additional level where consciousness can be studied using a combination of transcranial magnetic stimulation and EEG (TMS-EEG). This technique allows the direct stimulation of assemblies of cortical neurons and has been suggested as an efficient way to appreciate how the thalamocortical system can interact globally (integration) and produce specific responses (information).
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References
Giacino JT, Kalmar K, Whyte J. The JFK coma recovery scale-revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004;85(12):2020–9.
Gill-Thwaites H, Munday R. The sensory modality assessment and rehabilitation technique (SMART): a valid and reliable assessment for vegetative state and minimally conscious state patients. Brain Inj. 2004;18(12):1255–69.
Kalmar K, Giacino JT. The JFK coma recovery scale–revised. Neuropsychol Rehabil. 2005;15(3–4):454–60.
Shiel A, Horn SA, Wilson BA, et al. The wessex head injury matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury. Clin Rehabil. 2000;14(4):408–16.
Laureys S, Owen AM, Schiff ND. Brain function in coma, vegetative state, and related disorders. Lancet Neurol. 2004;3(9):537–46.
The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N Engl J Med. 1994;330(21):1499–508.
Giacino JT, Ashwal S, Childs N, et al. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002;58(3):349–53.
Schnakers C, Perrin F, Schabus M, et al. Detecting consciousness in a total locked-in syndrome: an active event-related paradigm. Neurocase. 2009;15(4):271–7.
Boly M, Coleman MR, Davis MH, et al. When thoughts become action: an fMRI paradigm to study volitional brain activity in non-communicative brain injured patients. Neuroimage. 2007;36(3):979–92.
Monti MM, Vanhaudenhuyse A, Coleman MR, et al. Willful modulation of brain activity in disorders of consciousness. N Engl J Med. 2010;362(7):579–89.
Owen AM, Coleman MR, Boly M, et al. Detecting awareness in the vegetative state. Science. 2006;313(5792):1402.
Giacino JT, Hirsch J, Schiff N, Laureys S. Functional neuroimaging applications for assessment and rehabilitation planning in patients with disorders of consciousness. Arch Phys Med Rehabil. 2006;87(12):67–76.
Massimini M, Boly M, Casali A, et al. A perturbational approach for evaluating the brain’s capacity for consciousness. Prog Brain Res. 2009;177:201–14.
Tononi G. Consciousness as integrated information: a provisional manifesto. Biol Bull. 2008;215(3):216–42.
Massimini M, Ferrarelli F, Huber R, et al. Breakdown of cortical effective connectivity during sleep. Science. 2005;309(5744):2228–32.
Massimini M, Ferrarelli F, Esser SK, et al. Triggering sleep slow waves by transcranial magnetic stimulation. Proc Natl Acad Sci USA. 2007;104(20):8496–501.
Ferrarelli F, Massimini M, Sarasso S, et al. Breakdown in cortical effective connectivity during midazolam-induced loss of consciousness. Proc Natl Acad Sci USA. 2010;107(6):2681–6.
Alkire MT, Hudetz AG, Tononi G. Consciousness and anesthesia. Science. 2008;322(5903):876–80.
Tononi G, Massimini M. Why does consciousness fade in early sleep? Ann N Y Acad Sci. 2008;1129:330–4.
Boly M, Massimini M, Tononi G. Theoretical approaches to the diagnosis of altered states of consciousness. Prog Brain Res. 2009;177:383–98.
Casarotto S, Romero Lauro LJ, Bellina V, et al. EEG responses to TMS are sensitive to changes in the perturbation parameters and repeatable over time. PLoS One. 2010;5(4):10281.
Rosanova M, Casali A, Bellina V, et al. Natural frequencies of human corticothalamic circuits. J Neurosci. 2009;29(24):7679–85.
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Boly, M., Gosseries, O., Bruno, MA., Rosanova, M., Massimini, M. (2012). Using Transcranial Magnetic Stimulation to Measure Cerebral Connectivity in Patients with Disorders of Consciousness. In: Schnakers, C., Laureys, S. (eds) Coma and Disorders of Consciousness. Springer, London. https://doi.org/10.1007/978-1-4471-2440-5_8
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DOI: https://doi.org/10.1007/978-1-4471-2440-5_8
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