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The neural bases of consciousness in the healthy and in the pathological brain

Abstract : The study of consciousness is a fascinating topic of investigation with a wide field of applications and implications. Consciousness processes can be divided into two orthogonal though intimately linked components: the conscious state, that is the state of vigilance or arousal, and the conscious content which refers to the external inputs perceived and manipulated in a conscious space. Although consciousness represents the most important human dimension where people's personal events are continuously experienced and remembered, it is somewhat surprising that its underlying neural processes still sparks lot of debates. In the first part of this PhD thesis, I took advantage from a well-known sensorimotor conflict paradigm, the Nielsen task, to investigate the neural correlates of the emergence of consciousness. Starting from the principle that much of motor processing occurs outside of awareness, I adapted the Nielsen paradigm to neurally investigate how the perception of a motor conflict in healthy subjects smoothly shifted along the unaware/aware state (i.e. point of subjective equality). Using EEG recordings, I then identify the brain sources which I consider the neural fingerprint of awareness. I found that the precuneus was critical for bringing the sensorimotor conflict into awareness. I also investigated this issue from a developmental perspective by examining the performance of healthy children. Although the timing of movement correction and the quality of movement trajectory in children was similar to adult subjects, motor awareness was shifted towards higher perception thresholds while parietal cortex activity was not found. Rather, children's response to conflict awareness was linked to SMA. After having addressed the topic of awareness in this first part, I will focus more on the second component, wakefulness. Usually these two components evolve together, however there are some pathological states in which they can be dissociated. It is the case for vegetative state patients who experience a state of wakefulness without awareness. In the second part of the thesis, I investigated the challenging hypothesis of a potential return to a conscious state, in a patient lying in a vegetative state for 15 years, after vagus nerve stimulation (VNS). We report beneficial effects of VNS including improved behavioural responsiveness and reinforced brain connectivity patterns as key signs of increased consciousness. The results showed an increase of information sharing a measure of functional connectivity particularly prominent across centro-posterior regions. Converging findings, coming from different methods, showed that VNS promoted the spread of cortical signals and metabolism which we found correlated with behavioural improvement as measured with the CRS-R scale. The VNS-induced changes are promising since they seem to follow an already known connectivity pattern characterizing state of consciousness improvements. Taken together, these findings indicate that the parietal lobe constitutes the neural correlate of both state and content-specific consciousness and suggest that this region is a "hot zone" for its emergence. Moreover, our first findings in a vegetative state patient also suggest that consciousness can be potentially repaired, thus opening the way to a new avenue of research in a domain where brain plasticity was underestimated
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Martina Corazzol. The neural bases of consciousness in the healthy and in the pathological brain. Neuroscience. Université de Lyon, 2017. English. ⟨NNT : 2017LYSE1298⟩. ⟨tel-01818817⟩

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