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An Unpredictable Brain Is a Conscious, Responsive Brain.

Sima Mofakham1, Jermaine Robertson1, Noah Lubin1

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Severe traumatic brain injury (TBI) can cause coma, characterized by simple brain activity. Recovery from this state is marked by increased cortical complexity and unpredictability, offering biomarkers for consciousness disorders.

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Area of Science:

  • Neuroscience
  • Neurology
  • Computational Neuroscience

Background:

  • Severe traumatic brain injuries (TBIs) often lead to loss of consciousness or coma.
  • In comatose patients, cortical dynamics simplify to repetitive and predictable patterns.
  • This passive cortical state is hypothesized to stem from disrupted thalamocortical input.

Purpose of the Study:

  • To review evidence linking low-complexity cortical dynamics in coma to a passive state hindering consciousness.
  • To explore the role of thalamocortical input loss in this passive state.
  • To identify electrophysiological biomarkers for consciousness recovery and inform therapeutic strategies.

Main Methods:

  • Review of existing data and literature on cortical dynamics in traumatic brain injury.
  • Analysis of local field potential (LFP) recordings to assess cortical complexity and predictability.
  • Hypothesis formulation regarding thalamocortical input and passive cortical states.

Main Results:

  • Cortical dynamics in deep coma are characterized by low complexity and high predictability, indicative of a passive state.
  • This passive state is associated with a stable, repetitive attractor that impedes neuronal ensemble formation necessary for consciousness.
  • Increased unpredictability and complexity in LFP signals signify recovery from the coma attractor.

Conclusions:

  • The passive cortical state in TBI-induced coma results from a loss of thalamocortical input.
  • Electrophysiological biomarkers, specifically cortical complexity and unpredictability, indicate the recovery of consciousness.
  • These biomarkers can guide the development of closed-loop stimulation for treating disorders of consciousness.