Brain state identification and neuromodulation to promote recovery of consciousness.

IF 4.1 Q1 CLINICAL NEUROLOGY
Brain communications Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI:10.1093/braincomms/fcae362
Glenn J M van der Lande, Diana Casas-Torremocha, Arnau Manasanch, Leonardo Dalla Porta, Olivia Gosseries, Naji Alnagger, Alice Barra, Jorge F Mejías, Rajanikant Panda, Fabio Riefolo, Aurore Thibaut, Vincent Bonhomme, Bertrand Thirion, Francisco Clasca, Pau Gorostiza, Maria V Sanchez-Vives, Gustavo Deco, Steven Laureys, Gorka Zamora-López, Jitka Annen
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引用次数: 0

Abstract

Experimental and clinical studies of consciousness identify brain states (i.e. quasi-stable functional cerebral organization) in a non-systematic manner and largely independent of the research into brain state modulation. In this narrative review, we synthesize advances in the identification of brain states associated with consciousness in animal models and physiological (sleep), pharmacological (anaesthesia) and pathological (disorders of consciousness) states of altered consciousness in humans. We show that in reduced consciousness the frequencies in which the brain operates are slowed down and that the pattern of functional communication is sparser, less efficient, and less complex. The results also highlight damaged resting-state networks, in particular the default mode network, decreased connectivity in long-range connections and especially in the thalamocortical loops. Next, we show that therapeutic approaches to treat disorders of consciousness, through pharmacology (e.g. amantadine, zolpidem), and (non-) invasive brain stimulation (e.g. transcranial direct current stimulation, deep brain stimulation) have shown partial effectiveness in promoting consciousness recovery. Although some features of conscious brain states may improve in response to neuromodulation, targeting often remains non-specific and does not always lead to (behavioural) improvements. The fields of brain state identification and neuromodulation of brain states in relation to consciousness are showing fascinating developments that, when integrated, might propel the development of new and better-targeted techniques for disorders of consciousness. We here propose a therapeutic framework for the identification and modulation of brain states to facilitate the interaction between the two fields. We propose that brain states should be identified in a predictive setting, followed by theoretical and empirical testing (i.e. in animal models, under anaesthesia and in patients with a disorder of consciousness) of neuromodulation techniques to promote consciousness in line with such predictions. This framework further helps to identify where challenges and opportunities lay for the maturation of brain state research in the context of states of consciousness. It will become apparent that one angle of opportunity is provided through the addition of computational modelling. Finally, it aids in recognizing possibilities and obstacles for the clinical translation of these diagnostic techniques and neuromodulation treatment options across both the multimodal and multi-species approaches outlined throughout the review.

大脑状态识别和神经调节,促进意识恢复。
有关意识的实验和临床研究以非系统的方式识别大脑状态(即准稳定的大脑功能组织),这些研究在很大程度上独立于大脑状态调节的研究。在这篇叙述性综述中,我们总结了在识别动物模型中与意识相关的大脑状态以及人类意识改变的生理(睡眠)、药理(麻醉)和病理(意识障碍)状态方面取得的进展。我们的研究表明,在意识减退时,大脑的工作频率会减慢,功能交流的模式会变得更稀疏、更低效和更复杂。研究结果还突显了静息态网络(尤其是默认模式网络)受损、长程连接性降低,特别是丘脑皮质环路的连接性降低。接下来,我们展示了通过药理学(如金刚烷胺、唑吡坦)和(非)侵入性脑刺激(如经颅直流电刺激、深部脑刺激)治疗意识障碍的方法在促进意识恢复方面的部分效果。虽然有意识的大脑状态的某些特征可能会因神经调节而有所改善,但目标往往仍然是非特异性的,并不总能带来(行为上的)改善。与意识相关的脑状态识别和脑状态神经调控领域正呈现出令人着迷的发展态势,如果将这两个领域结合起来,可能会推动开发出治疗意识障碍的更有针对性的新技术。我们在此提出一个识别和调节大脑状态的治疗框架,以促进这两个领域之间的互动。我们建议,应在预测环境下识别大脑状态,然后根据这些预测对神经调节技术进行理论和经验测试(即在动物模型、麻醉状态下和意识障碍患者身上),以促进意识。这一框架还有助于确定在意识状态背景下脑状态研究走向成熟所面临的挑战和机遇。很明显,通过增加计算建模,可以提供一个机会角度。最后,它还有助于识别这些诊断技术和神经调控治疗方案在临床应用中的可能性和障碍,包括整个综述中概述的多模式和多物种方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
0.00%
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审稿时长
6 weeks
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