Abstract A fundamental challenge in neuroscience is accurately defining brain states and predicting how and where to perturb the brain to force a transition. The ability to promote a transition from one brain state to another by externally driven stimulation could significantly impact rehabilitation and treatments for patients suffering from complex brain injury cases. Thus, it is crucial to find therapeutic interventions able to re-balance the dynamics of brain disorders towards more healthy regimes. Here, we investigated resting-state fMRI data of patients suffering from disorders of consciousness (DoC) after coma (minimally conscious and unresponsive wakefulness states) and healthy controls. We applied model-free and model-based approaches to help elucidate the underlying brain mechanisms of patients with DoC. The model-free approach allowed us to characterize brain states in DoC and healthy controls as a probabilistic metastable substate (PMS) space. The PMS of each group was characterized by a repertoire of unique patterns (i.e., metastable substates) with different probabilities of occurrence. In the model-based approach, we adjusted the PMS of each DoC group to a causal whole-brain model. This allowed us to explore optimal strategies for promoting a transition to the PMS of the control group by applying off-line in silico probing. Furthermore, this approach enabled us to evaluate the impact of all possible local perturbations in terms of their global effects and sensitivity to stimulation, which is a biomarker providing a deeper understanding of the mechanisms underlying DoC. Our results show that transitions from DoC to more healthy regimes were obtained in a synchronous protocol, in which areas from the motor and subcortical networks were the most sensitive to perturbation. This motivates further work to continue understanding brain function and treatments of disorders of consciousness by external stimulation. Author summary We studied disorders of consciousness by defining a brain state as a repertoire of metastable substates with different probabilities of occurrence. We created whole-brain computational models of DoC to uncover the causal mechanisms underlying recovery. These models allowed us to transition from DoC to a control healthy state by studying the effects of artificial individual local perturbations under different protocol regimes. We demonstrated successful transitions in the synchronization protocol and showed that the most sensitive areas were located in the motor network and subcortical regions. We believe this could be very valuable for developing clinical treatments and has a great deal for future therapies.

Re-awakening the brain: Forcing transitions in disorders of consciousness by externalin silicoperturbation