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November 12, 2024
Publications
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Review

Brain state identification and neuromodulation to promote recovery of consciousness

Publicated to: Brain Commun. 6 (5): fcae362- - 2024-10-29 6(5), DOI: 10.1093/braincomms/fcae362

Authors:

van der Lande, Glenn J M; van der Lande, Glenn J M; Casas-Torremocha, Diana; Manasanch, Arnau; Dalla Porta, Leonardo; Gosseries, Olivia; Alnagger, Naji; Barra, Alice; Mejias, Jorge F; Mejias, Jorge F; Panda, Rajanikant; Riefolo, Fabio; Thibaut, Aurore; Bonhomme, Vincent; Thirion, Bertrand; Clasca, Francisco; Gorostiza, Pau; Sanchez-Vives, Maria V; Sanchez-Vives, Maria V; Deco, Gustavo; Laureys, Steven; Zamora-Lopez, Gorka; Annen, Jitka
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Affiliations

Barcelona Inst Sci & Technol, Inst Bioengn Catalonia IBEC, Barcelona 08028, Spain - Author
Biomed Res Networking Ctr Bioengn Biomat & Nanomed, Madrid 28029, Spain - Author
Hangzhou Normal Univ, Int Consciousness Sci Inst, Hangzhou 311121, Peoples R China - Author
Inst Catalana Recerca & Estudis Avancats ICREA, Barcelona 08010, Spain - Author
Inst Invest Biomed August Pi i Sunyer IDIBAPS, Clin & Expt Neurosci, Barcelona 08036, Spain - Author
Liege Univ Hosp, Dept Anesthesia & Intens Care Med, B-4000 Liege, Belgium - Author
Teamit Inst, Barcelona Hlth Hub, Barcelona, Spain - Author
Univ Amsterdam, Swammerdam Inst Life Sci, NL-1098 XH Amsterdam, Netherlands - Author
Univ Autonoma Madrid, Sch Med, Dept Anat & Neurosci, Madrid 28029, Spain - Author
Univ Ghent, Dept Data Anal, B-9000 Ghent, Belgium - Author
Univ Hosp Liege, Ctr Cerveau, B-4000 Liege, Belgium - Author
Univ Laval, CERVO Brain Res Ctr, Joint Int Res Unit Consciousness, Quebec City, PQ G1J 2G3, Canada - Author
Univ Liege, GIGA Consciousness Themat Unit, Anesthesia & Perioperat Neurosci Lab, B-4000 Liege, Belgium - Author
Univ Liege, GIGA Consciousness, Coma Sci Grp, B-4000 Liege, Belgium - Author
Univ Paris Saclay, Inria, CEA, F-91120 Paris, France - Author
Univ Pompeu Fabra, Ctr Brain & Cognit, Computat Neurosci Grp, Barcelona 08018, Spain - Author
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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.
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Keywords

(disorders of) consciousnessAnaesthesiaAnimal modelAnimal modelsArea induces reanimationBrain statesDirect-current stimulationDisorderElectrical-stimulationFunctional connectivityGeneral-anesthesiaNeuromodulationPropofol-induced lossThalamic-stimulationTranscranial magnetic stimulationVegetative state

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Brain Commun due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2024 there are still no calculated indicators, but in 2023, it was in position 42/286, thus managing to position itself as a Q1 (Primer Cuartil), in the category Clinical Neurology.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2026-04-02:

  • WoS: 15
  • Europe PMC: 12
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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-02:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 19.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 16 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 3.
  • The number of mentions on the social network X (formerly Twitter): 3 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Belgium; Canada; China; France; Netherlands.

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Awards linked to the item

NA is research fellow, OG and AT are Research Associates, and SL is the research director at Fonds de la Recherche Scientifique (FRS-FNRS). JA is a postdoctoral fellow at the Fonds voor Wetenschappelijk Onderzoek (FWO) (1265522N). The study was further supported by the University and University Hospital of Liege, the BIAL Foundation, the Belgian National Funds for Scientific Research (FRS-FNRS), the European Union's Horizon 2020 Framework Programme for Research and Innovation under Specific Grant Agreement No. 945539 (Human Brain Project SGA3), the FNRS PDR project (T.0134.21), the ERA-Net FLAG-ERA JTC2021 project ModelDX Consciousness (Human Brain Project Partnering Project), the fund Generet, the King Baudouin Foundation, the Televie Foundation, the European Space Agency (ESA) and the Belgian Federal Science Policy Office (BELSPO) in the framework of the PROgramme de Developpement d'Experiences scientifiques (PRODEX Programme), the Public Utility Foundation 'Universite Europeenne du Travail', 'Fondazione Europea di Ricerca Biomedica', the BIAL Foundation, the Mind Science Foundation, the European Commission, the Fondation Leon Fredericq, the Mind-Care foundation, the DOCMA project (EU-H2020-MSCA-RISE-778234), the National Natural Science Foundation of China (Joint Research Project 81471100) and the European Foundation of Biomedical Research (FERB Onlus). EU grants ICT-36-2020-101016787 (DEEPER), EIC Pathfinder GAP- 101130883 (PHOTOTHERAPORT), and -EIC-2023-PATHF INDEROPEN-101130650 (META-BRAIN), Government of Catalonia AGAUR [Centres de Recerca de Catalunya (CERCA) Programme, 2021-SGR-01410; AGAUR 2021- SGR-01165 - NEUROVIRTUAL], Ministerio de Ciencia e Innovacion (MICINN) grants PID2019-111493RB-I00 (DEEP RED) and PID2022- 142609OB-I00 (EPILLUM), PID2020-112947RB-I00 financed by Ministerio de Ciencia e Innovacion (MCIN)/Agencia Estatal de Investigacion (AEI)/ 10.13039/501100011033 (CORTICOMOD), and Fundaluce and 'la Caixa' foundations (ID 100010434, agreement LCF/ PR/HR19/52160010).
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