ObjectiveValidating objective, brain‐based indices of consciousness in behaviorally unresponsive patients represents a challenge due to the impossibility of obtaining independent evidence through subjective reports. Here we address this problem by first validating a promising metric of consciousness—the Perturbational Complexity Index (PCI)—in a benchmark population who could confirm the presence or absence of consciousness through subjective reports, and then applying the same index to patients with disorders of consciousness (DOCs).MethodsThe benchmark population encompassed 150 healthy controls and communicative brain‐injured subjects in various states of conscious wakefulness, disconnected consciousness, and unconsciousness. Receiver operating characteristic curve analysis was performed to define an optimal cutoff for discriminating between the conscious and unconscious conditions. This cutoff was then applied to a cohort of noncommunicative DOC patients (38 in a minimally conscious state [MCS] and 43 in a vegetative state [VS]).ResultsWe found an empirical cutoff that discriminated with 100% sensitivity and specificity between the conscious and the unconscious conditions in the benchmark population. This cutoff resulted in a sensitivity of 94.7% in detecting MCS and allowed the identification of a number of unresponsive VS patients (9 of 43) with high values of PCI, overlapping with the distribution of the benchmark conscious condition.InterpretationGiven its high sensitivity and specificity in the benchmark and MCS population, PCI offers a reliable, independently validated stratification of unresponsive patients that has important physiopathological and therapeutic implications. In particular, the high‐PCI subgroup of VS patients may retain a capacity for consciousness that is not expressed in behavior. Ann Neurol 2016;80:718–729

Propofol anesthesia is a sleep-like state and slow waves are associated with diminished consciousness even in the presence of high gamma activity.

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2Consciousness never fades during wake. However, if awakened from sleep, sometimes we report dreams and sometimes no experiences. Traditionally, dreaming has been identified with REM sleep, characterized by a wake-like, globally 'activated', high-frequency EEG. However, dreaming also occurs in NREM sleep, characterized by prominent low-frequency activity. This challenges our understanding of the neural correlates of conscious experiences in sleep. Using high-density EEG, we contrasted the presence and absence of dreaming within NREM and REM sleep. In both NREM and REM sleep, the presence of dreaming was associated with a local decrease in low-frequency activity in posterior cortical regions. High-frequency activity within these regions correlated with specific dream contents. Monitoring this posterior 'hot zone' predicted the presence/absence of dreaming during NREM sleep in real time, suggesting that it may constitute a core correlate of conscious experiences in sleep.All rights reserved. No reuse allowed without permission.(which was not peer-reviewed) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint . http://dx.doi.org/10.1101/012443 doi: bioRxiv preprint first posted online Dec. 30, 2014; 3 An ongoing stream of experiences accompanies every waking moment. Sleep is the only time in which consciousness fades under normal physiological conditions: subjects awakened from sleep, especially early in the night, report that they were not experiencing anything up to 30% of the time 1 . At other times, subjects awakened from sleep report dreams -a stream of vivid experiences that occur despite being immobile, unresponsive, and largely disconnected from the environment. Thus, unlike wakefulness, sleep can be associated with either the presence or absence of conscious experiences. In addition, experiences in dreams can assume many forms, ranging from pure perceptual experiences to pure thought, from simple images to temporally unfolding narratives, which are often similar to awake conscious states but at times can be different in interesting ways 2,3 .The discovery of rapid eye movement (REM) sleep -the 'third state of being' besides wake and non-REM (NREM) sleep -led initially to a straightforward view of the neural correlates of dreaming 4 : the wake-like, high-frequency, 'activated' EEG 5,6 of REM sleep was thought to be associated with the presence of dream experiences, and the lowfrequency activity of NREM sleep with the absence of dreaming. However, later studies showed that up to 70% of NREM sleep awakenings yield reports of dream experiences 1 .Conversely, in a small but consistent minority of cases, subjects deny having had any experience when awakened from REM sleep. Thus, whether one experiences something or not during sleep cannot be determined simply by assessing one's behavioral state based on traditional EEG features or neuroimaging correlates 7,8 .The paradoxical occurrence of both the presence and absence of experien...

Unresponsive wakefulness syndrome (UWS) patients may retain intact portions of the thalamocortical system that are spontaneously active and reactive to sensory stimuli but fail to engage in complex causal interactions, resulting in loss of consciousness. Here, we show that loss of brain complexity after severe injuries is due to a pathological tendency of cortical circuits to fall into silence (OFF-period) upon receiving an input, a behavior typically observed during sleep. Spectral and phase domain analysis of EEG responses to transcranial magnetic stimulation reveals the occurrence of OFF-periods in the cortex of UWS patients (N = 16); these events never occur in healthy awake individuals (N = 20) but are similar to those detected in healthy sleeping subjects (N = 8). Crucially, OFF-periods impair local causal interactions, and prevent the build-up of global complexity in UWS. Our findings link potentially reversible local events to global brain dynamics that are relevant for pathological loss and recovery of consciousness.