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Episode 4 15.03.2018
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What if one-third of patients diagnosed as vegetative are actually conscious but trapped in bodies that cannot respond? Consciousness researcher Aurore Thibaut explains the 30% misdiagnosis rate in disorders of consciousness and how combining brain stimulation with complexity measures may finally give clinicians a reliable window into awareness when behavior fails. Subscribe for more from the Convergent Science Network podcast series. Aurore Thibaut of the University of Liège joins Paul Verschure at the BCBT summer school to discuss the clinical challenge of assessing consciousness in patients with severe brain injuries. Even with the best behavioral scale available, the Coma Recovery Scale-Revised, the misdiagnosis rate remains around 30%, because patients may be fully conscious yet unable to demonstrate it due to aphasia, motor impairment, pain, or fluctuating vigilance. Thibault describes the clinical categories from coma through unresponsive wakefulness syndrome to minimally conscious states, and explains why detecting the first sign of consciousness matters enormously for prognosis, rehabilitation decisions, and end-of-life choices. The discussion focuses on a promising approach that combines transcranial magnetic stimulation (TMS) with high-density EEG to measure the perturbational complexity index (PCI) , a single number reflecting how complex and differentiated the brain’s response is to a controlled perturbation. So far, this measure has achieved 100% accuracy in distinguishing conscious from unconscious states at the single-patient level, and has identified chronic patients classified as vegetative who later recovered. However, Thibault emphasizes that the technique is still in the research phase: sessions take hours, stimulation sites must be adapted to each patient’s lesion pattern, and it remains unknown whether the measure can predict recovery when applied in the acute stage. The conversation also explores the distinction between internal consciousness (self-directed thought, the default mode network) and external consciousness (awareness of the environment, the lateral frontoparietal network), the surprising finding that locked-in syndrome patients report happiness levels comparable to healthy controls, and the thalamocortical model that explains why certain drugs like zolpidem can transiently restore responsiveness in some patients. Key topics include clinical misdiagnosis of consciousness, the perturbational complexity index, TMS-EEG methodology, internal versus external consciousness networks, locked-in syndrome quality of life, and translating neuroscience tools into clinical practice. Part of the Convergent Science Network podcast series from the BCBT Summer School.
Tagged as:
Clinical Complexity Index consciousness disorders of consciousness Misdiagnosis Rate Perturbational Complexity vegetative state
About the author call_made
Both the triumphs of humanity and its most evil deeds have resulted from collaboration. In a time where humanity is required to aspire to the former and minimize the latter, the question arises of how collaboration arises and why it fails. Surprisingly, this phenomenon, so central to who we are, is not well understood. Hence, a collaborative effort is required to understand collaboration in its full biological, psychological, sociological, cultural, and economic complexity and to translate this understanding into operational impact. This series of podcasts is one step toward achieving these complementary goals. The Collaboration Podcast presents interviews with people who are central orchestrators of collaboration in various domains including business, government, science, art, health, sustainability, and the military. The discussions were conducted by Prof. Dr. Paul F.M.J. Verschure and members of the Program Advisory Committee of the Ernst Strungmann Forum on Collaboration (https://www.esforum.de/forums/ESF32_Collaboration.html) during 2021 and had the goal to sketch a map of opportunities, challenges, and obstacles in human collaboration. The forum took place in May 2022, and now we would like to share this series of interviews with a broader audience. The full report of the Forum will be published in 2023 by MIT Press. The podcast was produced by the Convergent Science Network (https://www.convergentsciencenetwork.org/). Context: The stability of social systems depends critically on realizing sustainable methods of “collaboration,” yet how and by which means collaboration is achieved is not clearly understood; neither are the conditions or processes that lead to its breakdown or failure. Collaboration can be understood as cooperation between agents toward mutually constructed goals. Part of the reason for our lack of understanding is that the phenomenon of collaboration is, by nature, a highly multidisciplinary problem, and effective research into its complexities has been difficult to achieve across the broad range of scientific and technical disciplines involved. The need for a fundamental understanding of collaboration, however, has become increasingly important. Not only does humankind demand answers as it attempts to address critical challenges at multiple scales (e.g., climate change, migration, enhanced automation, social and economic inequality), but ever-increasing technological and economic means of interconnecting people and societies are disrupting long-established, familiar patterns of how we interact. Radical technological changes that are ongoing have the potential to reshape collaboration in ways that are currently hard to predict or influence (e.g., by altering configurations in interaction, information creation, and modes of communication). On one hand, such changes could disrupt hitherto stable forms of collaboration by affecting critical communication channels and traditional roles, as can be observed in the rapidly changing patterns in governance, commerce, and social interaction. Conversely, technology could lead to the emergence of novel, successful forms of collaboration that deviate from traditional “hierarchical” architectures. Evidence of this can be seen in areas as diverse as highly automated manufacturing plants, the open science movement, collaborative software repositories, user-centered services, and the sharing of economy-based modes of organization. Without a fundamental understanding of the mechanisms, processes, and boundary conditions of collaboration, it is not possible to evaluate or predict which of these possible scenarios are sustainable or even plausible. The Forum “How Collaboration Arises and Why it Fails” (May 8–13, 2022, Location: Frankfurt am Main, Germany) Chairs: Andreas Roepstorff and Paul Verschure Program Advisory Committee: Jenna Bednar, Julia R. Lupp, Bhavani R. Rao , Andreas Roepstorff, Ferdinand von Siemens, and Paul Verschure
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