Scientific Understanding of Consciousness
Consciousness as an Emergent Property of Thalamocortical Activity

Reorganised Brain Networks in Disorders of Consciousness


PloS Computational Biology, Published: October 16, 2014

Spectral Signatures of Reorganised Brain Networks in Disorders of Consciousness

Srivas Chennu,

Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom

Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, United Kingdom

Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom

Department of Psychology, University of California at Los Angeles, Los Angeles, California, United States of America

Department of Psychology, University of Cambridge, Cambridge, United Kingdom

Division of Anaesthesia, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom

Laboratory of Cognitive and Social Neuroscience, Universidad Diego Portales, Santiago, Chile

Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, United Kingdom

The Brain and Mind Institute, Natural Sciences Centre, The University of Western Ontario, London, Ontario, Canada

Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom


What are the neural signatures of consciousness? This is an elusive yet fascinating challenge to current cognitive neuroscience, but it takes on an immediate clinical and societal significance in patients diagnosed as vegetative and minimally conscious. In these patients, it leads us to ask whether we can test for the presence of these signatures in the absence of any external signs of awareness. Recent conceptual advances suggest that consciousness requires a dynamic balance between integrated and differentiated networks of information exchange between brain regions. Here we apply this insight to study such networks in patients and compare them to healthy adults. Using the science of graph theory, we show that the rich and diversely connected networks that support awareness are characteristically impaired in patients, lacking the ability to efficiently integrate information across disparate regions via well-connected hubs. We find that the quality of patients' networks also correlates well with their degree of behavioural responsiveness, and some vegetative patients who show signs of hidden awareness have remarkably well-preserved networks similar to healthy adults. Overall, our research highlights distinctive network signatures of pathological unconsciousness, which could improve clinical assessment and help identify patients who are aware despite being uncommunicative.

There has been considerable recent interest in the view that consciousness is a phenomenon emerging from the dynamic equilibrium between differentiated and integrated information processing in the brain. This view has inspired research into ways of quantifying the characteristics of information exchange in the brain at rest, and how this modulated in natural sleep, pharmacological sedation, and pathological coma and disorders of consciousness (DoC; including the vegetative and minimally conscious states, VS and MCS). In this latter case, such theoretical questions about the neural bases of consciousness take on a clinical and societal significance, as they could inform diagnosis, prognosis and treatment of DoC, which are often brought on by severe injury to the brain. Recent advances in the use of neuroimaging to better ascertain brain function in DoC have yielded some surprises, and indicated that a significant minority of patients are able to volitionally modulate brain activity in ways that would normally require high-level cognition and even covert awareness despite no behaviourally evident signs thereof.

Such findings have motivated parallel research into the study of brain connectivity in patients at rest, using MRI, EEG and TMS to derive surrogate measure of information integration and differentiation. Modern neuroimaging methods for assaying such connectivity, including Magnetic Resonance Imaging (MRI) and high-density electroencephalography (EEG), provide a surfeit of data that need to be reduced in dimensionality and coalesced into patterns to provide an overarching understanding of connectivity networks in the brain. Graph-theoretical analysis of such networks has provided an elegant way to achieve this synthesis using resting state connectivity data in sleep, sedation and coma.

Here, we apply graph theory to extract patterns of information integration in brain networks derived from bedside measurement of high-density EEG in DoC patients, alongside normative networks observed in healthy controls. From 10 minutes of high-density EEG data, we calculate networks of sustained, coherent oscillatory activity within canonical frequency bands, which are prominent and commonly clinically evaluated in DoC. We will show that graph-theoretical metrics highlight contrasting signatures of connectivity in healthy and pathological brains across different frequency bands. These signatures, encompassing measures of topology as well as topography, will allow us to address a set of inter-related questions of fundamental neuroscientific importance: for example, what is distinctive about network dysfunction in pathological states of low awareness? To what extent are these network signatures consistent across patients? How do they correlate with the complexity of preserved behavioural responses? And perhaps most intriguingly, what network signatures can we observe in patients who seem behaviourally vegetative, but nevertheless demonstrate signs of covert awareness.

The findings are an exposition of the prominent changes to the spectral characteristics of resting state EEG in 32 DoC patients and 26 healthy controls. We begin with a description of changes in spectral power accompanying DoC, reiterating some well-established findings in the literature. These power-related changes are driven by fundamental alterations in the relative amplitude of ambient cortical oscillations commonly observed in the resting brain. We then move to novel analyses of changes in the structure of brain networks functionally unified by these oscillations. These changes are measured by spectral connectivity, which is derived from ongoing phase relationships between cortical oscillations.

We assessed connectivity between EEG electrodes to investigate the structure of brain networks in the delta, theta and alpha bands.

The clustering coefficient of a network captures its micro-scale (local) efficiency.

In contrast to the clustering coefficient, the macro-scale characteristic path length measures the average topological distance between pairs of nodes in a graph, providing an indication of global efficiency.

Modularity is a meso-scale network metric that encapsulates the degree to which the nodes of a network can be parcellated into densely connected, topologically distinct modules with relatively few inter-modular connections.

Previous research into resting state networks involving patients in acute coma and chronic disorders of consciousness has reported on the disruption of structural and functional connectivity following brain injury. Researchers have employed graph-theoretic analysis of resting state fMRI scans and found that there was significant restructuring of network hubs in comatose patients. We investigated whether similar patterns could be observed in EEG networks in our group of DoC patients, using a normalised mutual information (NMI) metric.

While clustering, path length, modularity and participation coefficient quantify key topological characteristics of networks, they are by definition unaware of the topographical structure of the EEG networks considered here. To address this, we employed a novel network metric, modular span, which measured the average weighted topographical distance (over the scalp) spanned by a module identified in a network.

The exploration of resting state EEG described above adds to convergent understanding of how structured connectivity in human brain networks is disrupted in DoC. Generally speaking, our graph-theoretical quantification showed that alpha networks in the healthy brain were balanced between strong local interactions (high clustering) and robust interconnectivity (more intermodular hubs). Such configurations in the alpha band were absent in patients, and provided a network-based account of the role of structured alpha connectivity in subserving arousal and awareness. This difference between patients and healthy controls is consistent with evidence from fMRI resting networks.

The short EEG recordings as analysed here are commonly measured in DoC patients in hospitals around the world, and clinically interpreted by eye by electrophysiologists. These could potentially become much more clinically informative if powerful analytical tools are used to unveil the capacity of cortical integration and differentiation, as captured by networks analyses such as those presented here. Combining easy-to-administer and inexpensive EEG with developments in network science could allow us to make inferences about information transfer across multiple scales of brain dynamics, and ultimately aid diagnosis and prognosis in this challenging group of patients.

Our analysis of EEG connectivity in high-density networks at rest found that DoC patients had comparatively reduced graph-theoretic network efficiency in the alpha band as compared to healthy controls. Using a novel metric termed modular span that embedded topologically derived modules in topographical space, we established that the alpha network modules in patients were also spatially limited, with a prominent absence of the structured long-distance connectivity commonly observed in healthy networks. Importantly however, the observed differences between graph-theoretic metrics were partially reversed in the networks within the delta and theta bands. Here we noted the presence of robust connectivity patterns that were in fact commonly structured across patients, suggesting that there could be some degree of reorganisation, rather than just disorganisation, of brain networks in DoC. However, network modules in these lower bands did not have spatial spans that characterised healthy alpha modules. This finding addresses the question of why these lower band networks could not subserve balanced cortical integration and differentiation thought to be concomitant with normal consciousness. Going further, we found that alpha network metrics in patients clearly correlated with their behavioural scores on the CRS-R. Interestingly, we observed that some behaviourally vegetative patients who demonstrated evidence of command following with fMRI tennis imagery tended to deviate from this trend: their alpha networks were remarkably well preserved and were similar to those observed in healthy controls. On the whole, our findings describe distinctive signatures of brain networks in chronic disorders of consciousness. Further, in the significant minority of vegetative patients who show signs of covert awareness, they point to putative network mechanisms that could support high-level cognitive function despite behavioural impairment.

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