Simultaneous invasive and non-invasive recordings in humans: a novel Rosetta stone for deciphering brain activity.

Simultaneous noninvasive and invasive electrophysiological recordings provide a unique opportunity to achieve a comprehensive understanding of human brain activity, much like a Rosetta stone for human neuroscience. In this review we focus on the increasingly-used powerful combination of intracranial electroencephalography (iEEG) with scalp electroencephalography (EEG) or magnetoencephalography (MEG). We first provide practical insight on how to achieve these technically challenging recordings. We then provide examples from clinical research on how simultaneous recordings are advancing our understanding of epilepsy. This is followed by the illustration of how human neuroscience and methodological advances could benefit from these simultaneous recordings. We conclude with a call for open data sharing and collaboration, while ensuring neuroethical approaches and argue that only with a true collaborative approach the promises of simultaneous recordings will be fulfilled.

Cognitive decline related to chronic kidney disease as an exclusion factor from kidney transplantation: results from an international survey.

Background and hypothesis: There seems to be a lack of consensus on the necessity and the modality of psychological and specifically cognitive assessment of candidates for kidney transplantation. Both points are often delegated to individual hospitals/centres, whereas international guidelines are inconsistent. We think it is essential to investigate professionals' opinions to advance towards a consistent clinical practice. Methods: This paper presents the results of an international survey among clinical professionals, mainly nephrologists from the CONNECT (Cognitive decline in Nephro-Neurology: European Cooperative Target) network and beyond (i.e. from personal contacts of CONNECT members). The survey investigated their opinions about the question of whether cognitive decline in patients with chronic kidney disease may affect their eligibility for kidney transplantation. Results: Our results show that most clinicians working with patients affected by chronic kidney disease think that cognitive decline may challenge their eligibility for transplantation despite data that suggest that, in some patients, cognitive problems improve after kidney transplantation. Conclusion: We conclude that three needs emerge as particularly pressing: defining agreed-on standards for a multifaceted and multifactorial assessment (i.e. including both clinical/medical and psychosocial factors) of candidates with chronic kidney disease to kidney transplantation; further investigating empirically the causal connection between chronic kidney disease and cognition; and further investigating empirically the possible partial reversibility of cognitive decline after kidney transplantation.

International survey on the implementation of the European and American guidelines on disorders of consciousness.

Diagnostic, prognostic, and therapeutic procedures for patients with prolonged disorders of consciousness (pDoCs) vary significantly across countries and clinical settings, likely due to organizational factors (e.g., research vs. non-academic hospitals), expertise and availability of resources (e.g., financial and human). Two international guidelines, one from the European Academy of Neurology (EAN) and one from the American Academy of Neurology (AAN) in collaboration with the American Congress of Rehabilitation Medicine (ACRM) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), were developed to facilitate consistent practice among professionals working with this challenging patient population. While the recommendations of both guidelines agree in principle, it remains an open issue how to implement them into clinical practice in the care pathway for patients with pDoCs. We conducted an online survey to explore health professional clinical practices related to the management of patients with pDoCs, and compare said practices with selected recommendations from both the guidelines. The survey revealed that while some recommendations are being followed, others are not and/or may require more honing/specificity to enhance their clinical utility. Particular attention should be given to the implementation of a multimodal assessment of residual consciousness, to the detection and treatment of pain, and to the impact of restrictions imposed by COVID-19 pandemics on the involvement of patients' families/representatives.

About the compatibility between the perturbational complexity index and the global neuronal workspace theory of consciousness.

This paper investigates the compatibility between the theoretical framework of the global neuronal workspace theory (GNWT) of conscious processing and the perturbational complexity index (PCI). Even if it has been introduced within the framework of a concurrent theory (i.e. Integrated Information Theory), PCI appears, in principle, compatible with the main tenet of GNWT, which is a conscious process that depends on a long-range connection between different cortical regions, more specifically on the amplification, global propagation, and integration of brain signals. Notwithstanding this basic compatibility, a number of limited compatibilities and apparent differences emerge. This paper starts from the description of brain complexity, a notion that is crucial for PCI, to then summary of the main features of PCI and the main tenets of GNWT. Against this background, the text explores the compatibility between PCI and GNWT. It concludes that GNWT and PCI are fundamentally compatible, even though there are some partial disagreements and some points to further examine.

What names for covert awareness? A systematic review.

Background: With the emergence of Brain Computer Interfaces (BCI), clinicians have been facing a new group of patients with severe acquired brain injury who are unable to show any behavioral sign of consciousness but respond to active neuroimaging or electrophysiological paradigms. However, even though well documented, there is still no consensus regarding the nomenclature for this clinical entity. Objectives: This systematic review aims to 1) identify the terms used to indicate the presence of this entity through the years, and 2) promote an informed discussion regarding the rationale for these names and the best candidates to name this fascinating disorder. Methods: The Disorders of Consciousness Special Interest Group (DoC SIG) of the International Brain Injury Association (IBIA) launched a search on Pubmed and Google scholar following PRISMA guidelines to collect peer-reviewed articles and reviews on human adults (>18 years) published in English between 2006 and 2021. Results: The search launched in January 2021 identified 4,089 potentially relevant titles. After screening, 1,126 abstracts were found relevant. Finally, 161 manuscripts were included in our analyses. Only 58% of the manuscripts used a specific name to discuss this clinical entity, among which 32% used several names interchangeably throughout the text. We found 25 different names given to this entity. The five following names were the ones the most frequently used: covert awareness, cognitive motor dissociation, functional locked-in, non-behavioral MCS (MCS*) and higher-order cortex motor dissociation. Conclusion: Since 2006, there has been no agreement regarding the taxonomy to use for unresponsive patients who are able to respond to active neuroimaging or electrophysiological paradigms. Developing a standard taxonomy is an important goal for future research studies and clinical translation. We recommend a Delphi study in order to build such a consensus.

Indicators and criteria of consciousness: ethical implications for the care of behaviourally unresponsive patients.

BACKGROUND: Assessing consciousness in other subjects, particularly in non-verbal and behaviourally disabled subjects (e.g., patients with disorders of consciousness), is notoriously challenging but increasingly urgent. The high rate of misdiagnosis among disorders of consciousness raises the need for new perspectives in order to inspire new technical and clinical approaches. MAIN BODY: We take as a starting point a recently introduced list of operational indicators of consciousness that facilitates its recognition in challenging cases like non-human animals and Artificial Intelligence to explore their relevance to disorders of consciousness and their potential ethical impact on the diagnosis and healthcare of relevant patients. Indicators of consciousness mean particular capacities that can be deduced from observing the behaviour or cognitive performance of the subject in question (or from neural correlates of such performance) and that do not define a hard threshold in deciding about the presence of consciousness, but can be used to infer a graded measure based on the consistency amongst the different indicators. The indicators of consciousness under consideration offer a potential useful strategy for identifying and assessing residual consciousness in patients with disorders of consciousness, setting the theoretical stage for an operationalization and quantification of relevant brain activity. CONCLUSIONS: Our heuristic analysis supports the conclusion that the application of the identified indicators of consciousness to its disorders will likely inspire new strategies for assessing three very urgent issues: the misdiagnosis of disorders of consciousness; the need for a gold standard in detecting consciousness and diagnosing its disorders; and the need for a refined taxonomy of disorders of consciousness.

Towards Establishing Criteria for the Ethical Analysis of Artificial Intelligence.

Ethical reflection on Artificial Intelligence (AI) has become a priority. In this article, we propose a methodological model for a comprehensive ethical analysis of some uses of AI, notably as a replacement of human actors in specific activities. We emphasize the need for conceptual clarification of relevant key terms (e.g., intelligence) in order to undertake such reflection. Against that background, we distinguish two levels of ethical analysis, one practical and one theoretical. Focusing on the state of AI at present, we suggest that regardless of the presence of intelligence, the lack of morally relevant features calls for caution when considering the role of AI in some specific human activities.

Of Ethical Frameworks and Neuroethics in Big Neuroscience Projects: A View from the HBP.

The recently published BRAIN 2.0 Neuroethics Report offers a very helpful overview of the possible ethical, social, philosophical, and legal issues raised by neuroscience in the context of BRAIN's research priorities thus contributing to the attempt to develop ethically sound neuroscience. In this article, we turn to a running theme of the document: the need for an ethical framework for the BRAIN Initiative and for further integration of neuroethics and neuroscience. We assess some of the issues raised and provide an explanation of how we have addressed them in the Human Brain Project. We offer our experience in the HBP as a potential contribution to the international debate about neuroethics in the big brain initiatives. Our hope is that among other things, the type of exchange proposed by this AJOB special issue will prove productive in further identifying and discussing the issues and in inspiring appropriate solutions.

Anthropomorphism in AI.

AI research is growing rapidly raising various ethical issues related to safety, risks, and other effects widely discussed in the literature. We believe that in order to adequately address those issues and engage in a productive normative discussion it is necessary to examine key concepts and categories. One such category is anthropomorphism. It is a well-known fact that AI's functionalities and innovations are often anthropomorphized (i.e., described and conceived as characterized by human traits). The general public's anthropomorphic attitudes and some of their ethical consequences (particularly in the context of social robots and their interaction with humans) have been widely discussed in the literature. However, how anthropomorphism permeates AI research itself (i.e., in the very language of computer scientists, designers, and programmers), and what the epistemological and ethical consequences of this might be have received less attention. In this paper we explore this issue. We first set the methodological/theoretical stage, making a distinction between a normative and a conceptual approach to the issues. Next, after a brief analysis of anthropomorphism and its manifestations in the public, we explore its presence within AI research with a particular focus on brain-inspired AI. Finally, on the basis of our analysis, we identify some potential epistemological and ethical consequences of the use of anthropomorphic language and discourse within the AI research community, thus reinforcing the need of complementing the practical with a conceptual analysis.

Indicators and Criteria of Consciousness in Animals and Intelligent Machines: An Inside-Out Approach.

In today's society, it becomes increasingly important to assess which non-human and non-verbal beings possess consciousness. This review article aims to delineate criteria for consciousness especially in animals, while also taking into account intelligent artifacts. First, we circumscribe what we mean with "consciousness" and describe key features of subjective experience: qualitative richness, situatedness, intentionality and interpretation, integration and the combination of dynamic and stabilizing properties. We argue that consciousness has a biological function, which is to present the subject with a multimodal, situational survey of the surrounding world and body, subserving complex decision-making and goal-directed behavior. This survey reflects the brain's capacity for internal modeling of external events underlying changes in sensory state. Next, we follow an inside-out approach: how can the features of conscious experience, correlating to mechanisms inside the brain, be logically coupled to externally observable ("outside") properties? Instead of proposing criteria that would each define a "hard" threshold for consciousness, we outline six indicators: (i) goal-directed behavior and model-based learning; (ii) anatomic and physiological substrates for generating integrative multimodal representations; (iii) psychometrics and meta-cognition; (iv) episodic memory; (v) susceptibility to illusions and multistable perception; and (vi) specific visuospatial behaviors. Rather than emphasizing a particular indicator as being decisive, we propose that the consistency amongst these indicators can serve to assess consciousness in particular species. The integration of scores on the various indicators yields an overall, graded criterion for consciousness, somewhat comparable to the Glasgow Coma Scale for unresponsive patients. When considering theoretically derived measures of consciousness, it is argued that their validity should not be assessed on the basis of a single quantifiable measure, but requires cross-examination across multiple pieces of evidence, including the indicators proposed here. Current intelligent machines, including deep learning neural networks (DLNNs) and agile robots, are not indicated to be conscious yet. Instead of assessing machine consciousness by a brief Turing-type of test, evidence for it may gradually accumulate when we study machines ethologically and across time, considering multiple behaviors that require flexibility, improvisation, spontaneous problem-solving and the situational conspectus typically associated with conscious experience.

Realigning the Neural Paradigm for Death.

Whole brain failure constitutes the diagnostic criterion for death determination in most clinical settings across the globe. Yet the conceptual foundation for its adoption was slow to emerge, has evoked extensive scientific debate since inception, underwent policy revision, and remains contentious in praxis even today. Complications result from the need to relate a unitary construal of the death event with an adequate account of organismal integration and that of the human organism in particular. Advances in the neuroscience of higher human faculties, such as the self, personal identity, and consciousness, and dynamical philosophy of science accounts, however, are yielding a portrait of higher order global integration shared between body and brain. Such conceptual models of integration challenge a praxis relying exclusively on a neurological criterion for death.

The Human Brain Project: Responsible Brain Research for the Benefit of Society.

Recognizing that its research may raise various ethical, social, and philosophical issues, the HBP has made the identification, examination, and management of those issues a top priority. The Ethics and Society subproject is part of the core research project.

Drug Addiction: From Neuroscience to Ethics.

In the present paper, we suggest a potential new ethical analysis of addiction focusing on the relationship between aware and unaware processing in the brain. We take the case of the opioids epidemics to argue that a consideration of both aware and unaware processing provides a more comprehensive ethical framework to discuss the ethical issues raised by addiction. Finally, our hypothesis is that in addition to identified Central Nervous System's neuronal/neurochemical factors contributing to addictive dynamics, the socio-economic status plays a causal role through epigenetic processes, originating the need for additional reward in the brain. This provides a strong base for a socio-political form of responsibility for preventing and managing addiction crisis.

Neuroethics: A Conceptual Approach.

In this article, we begin by identifying three main neuroethical approaches: neurobioethics, empirical neuroethics, and conceptual neuroethics. Our focus is on conceptual approaches that generally emphasize the need to develop and use a methodological modus operandi for effectively linking scientific (i.e., neuroscience) and philosophical (i.e., ethics) interpretations. We explain and assess the value of conceptual neuroethics approaches and explain and defend one such approach that we propose as being particularly fruitful for addressing the various issues raised by neuroscience: fundamental neuroethics.

Large-Scale Brain Simulation and Disorders of Consciousness. Mapping Technical and Conceptual Issues.

Modeling and simulations have gained a leading position in contemporary attempts to describe, explain, and quantitatively predict the human brain's operations. Computer models are highly sophisticated tools developed to achieve an integrated knowledge of the brain with the aim of overcoming the actual fragmentation resulting from different neuroscientific approaches. In this paper we investigate the plausibility of simulation technologies for emulation of consciousness and the potential clinical impact of large-scale brain simulation on the assessment and care of disorders of consciousness (DOCs), e.g., Coma, Vegetative State/Unresponsive Wakefulness Syndrome, Minimally Conscious State. Notwithstanding their technical limitations, we suggest that simulation technologies may offer new solutions to old practical problems, particularly in clinical contexts. We take DOCs as an illustrative case, arguing that the simulation of neural correlates of consciousness is potentially useful for improving treatments of patients with DOCs.