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A theoretically based index of consciousness independent of sensory processing and behavior.
[locked-in syndrome]
One
challenging
aspect
of
the
clinical
assessment
of
brain
-injured
,
unresponsive
patients
is
the
lack
of
an
objective
measure
of
consciousness
that
is
independent
of
the
subject
's
ability
to
interact
with
the
external
environment
.
Theoretical
considerations
suggest
that
consciousness
depends
on
the
brain
's
ability
to
support
complex
activity
patterns
that
are
,
at
once
,
distributed
among
interacting
cortical
areas
(
integrated
)
and
differentiated
in
space
and
time
(
information-rich
)
.
We
introduce
and
test
a
theory-driven
index
of
the
level
of
consciousness
called
the
perturbational
complexity
index
(
PCI
)
.
PCI
is
calculated
by
(
i
)
perturbing
the
cortex
with
transcranial
magnetic
stimulation
(
TMS
)
to
engage
distributed
interactions
in
the
brain
(
integration
)
and
(
ii
)
compressing
the
spatiotemporal
pattern
of
these
electrocortical
responses
to
measure
their
algorithmic
complexity
(
information
)
.
We
test
PCI
on
a
large
data
set
of
TMS-evoked
potentials
recorded
in
healthy
subjects
during
wakefulness
,
dreaming
,
nonrapid
eye
movement
sleep
,
and
different
levels
of
sedation
induced
by
anesthetic
agents
(
midazolam
,
xenon
,
and
propofol
)
,
as
well
as
in
patients
who
had
emerged
from
coma
(
vegetative
state
,
minimally
conscious
state
,
and
locked-
in
syndrome
)
.
PCI
reliably
discriminated
the
level
of
consciousness
in
single
individuals
during
wakefulness
,
sleep
,
and
anesthesia
,
as
well
as
in
patients
who
had
emerged
from
coma
and
recovered
a
minimal
level
of
consciousness
.
PCI
can
potentially
be
used
for
objective
determination
of
the
level
of
consciousness
at
the
bedside
.
Diseases
Validation
Diseases presenting
"complex activity patterns"
symptom
locked-in syndrome
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