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@ARTICLE{Zilio:259235,
      author       = {Zilio, Federico and Gomez-Pilar, Javier and Chaudhary,
                      Ujwal and Fogel, Stuart and Fomina, Tatiana and Synofzik,
                      Matthis and Schöls, Ludger and Cao, Shumei and Zhang, Jun
                      and Huang, Zirui and Birbaumer, Niels and Northoff, Georg},
      title        = {{A}ltered brain dynamics index levels of arousal in
                      complete locked-in syndrome.},
      journal      = {Communications biology},
      volume       = {6},
      number       = {1},
      issn         = {2399-3642},
      address      = {London},
      publisher    = {Springer Nature},
      reportid     = {DZNE-2023-00736},
      pages        = {757},
      year         = {2023},
      abstract     = {Complete locked-in syndrome (CLIS) resulting from
                      late-stage amyotrophic lateral sclerosis (ALS) is
                      characterised by loss of motor function and eye movements.
                      The absence of behavioural indicators of consciousness makes
                      the search for neuronal correlates as possible biomarkers
                      clinically and ethically urgent. EEG-based measures of brain
                      dynamics such as power-law exponent (PLE) and Lempel-Ziv
                      complexity (LZC) have been shown to have explanatory power
                      for consciousness and may provide such neuronal indices for
                      patients with CLIS. Here, we validated PLE and LZC
                      (calculated in a dynamic way) as benchmarks of a wide range
                      of arousal states across different reference states of
                      consciousness (e.g., awake, sleep stages, ketamine,
                      sevoflurane). We show a tendency toward high PLE and low
                      LZC, with high intra-subject fluctuations and inter-subject
                      variability in a cohort of CLIS patients with values graded
                      along different arousal states as in our reference data
                      sets. In conclusion, changes in brain dynamics indicate
                      altered arousal in CLIS. Specifically, PLE and LZC are
                      potentially relevant biomarkers to identify or diagnose the
                      arousal level in CLIS and to determine the optimal time
                      point for treatment, including communication attempts.},
      keywords     = {Humans / Locked-In Syndrome / Electroencephalography:
                      methods / Brain: physiology / Wakefulness / Biomarkers /
                      Biomarkers (NLM Chemicals)},
      cin          = {AG Gasser / AG Schöls},
      ddc          = {570},
      cid          = {I:(DE-2719)1210000 / I:(DE-2719)5000005},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37474587},
      pmc          = {pmc:PMC10359418},
      doi          = {10.1038/s42003-023-05109-1},
      url          = {https://pub.dzne.de/record/259235},
}