{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:57:08Z","timestamp":1790740628124,"version":"4.1.0"},"reference-count":97,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:p>Research indicates that locked-in syndrome (LIS) patients retain both consciousness and cognitive functions, despite their inability to perform voluntary muscle movements or communicate. Brain-Computer Interfaces (BCIs) provide a means for these patients to communicate, which is crucial, as the ability to interact with their environment has been shown to significantly enhance their wellbeing and quality of life. This paper presents an innovative approach to analyzing electroencephalogram (EEG) data from four LIS patients to assess their consciousness levels, referred to as normalized consciousness levels (NCL) in this study. It consists of extracting different features based on frequency, complexity, and connectivity measures to maximize the probability of correctly determining the patients' actual states given the inexistence of ground truth. The consciousness levels derived from this approach aim to improve our understanding of the patients' condition, which is vital in order to build effective communication systems. Despite considerable inter-patient variability, the findings indicate that the approach is effective in detecting neural markers of consciousness and in differentiating between states across the majority of patients. By accurately assessing consciousness, this research aims to improve diagnosis in addition to determining the optimal time to initiate communication with these non-communicative patients. It is important to note that consciousness is a complex and difficult concept to define. In this study, the term \u201cconsciousness level\u201d does not refer to a medical definition. Instead, it represents a scale of NCL values ranging from 0 to 1 representing the likelihood of the patient being fully conscious (1) or not (0).<\/jats:p>","DOI":"10.3389\/fnins.2025.1604173","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T05:24:25Z","timestamp":1757568265000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Assessing consciousness in patients with locked-in syndrome using their EEG"],"prefix":"10.3389","volume":"19","author":[{"given":"Sophie","family":"Adama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bogdan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.cmpb.2008.10.001","article-title":"A new approach for EEG feature extraction in P300-based lie detection","volume":"94","author":"Abootalebi","year":"2009","journal-title":"Comput. Methods Programs Biomed"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2282","DOI":"10.1109\/TBME.2006.883696","article-title":"Interpretation of the Lempel-Ziv complexity measure in the context of biomedical signal analysis","volume":"53","author":"Aboy","year":"2006","journal-title":"IEEE Trans. Biomed. Eng"},{"key":"B3","doi-asserted-by":"publisher","first-page":"65","DOI":"10.3390\/brainsci13010065","article-title":"Application of soft-clustering to assess consciousness in a CLIS patient","volume":"13","author":"Adama","year":"","journal-title":"Brain Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s40708-023-00197-5","article-title":"Assessing consciousness in patients with disorders of consciousness using soft-clustering","volume":"10","author":"Adama","year":"","journal-title":"Brain Inf"},{"key":"B5","article-title":"\u201cExtendable hybrid approach to detect conscious states in a CLIS patient using machine learning,\u201d","volume-title":"Abstracts of the 10th EUROSIM Congress on Modelling and Simulation","author":"Adama","year":"2019"},{"key":"B6","doi-asserted-by":"publisher","first-page":"10596","DOI":"10.11128\/sne.32.tn.10596","article-title":"Extendable hybrid approach to detect conscious states in a CLIS patient using machine learning","volume":"31","author":"Adama","year":"2021","journal-title":"Simulat. Notes Europe SNE"},{"key":"B7","doi-asserted-by":"publisher","first-page":"748","DOI":"10.3390\/brainsci10100748","article-title":"Auditory and somatosensory P3 are complementary for the assessment of patients with disorders of consciousness","volume":"10","author":"Annen","year":"2020","journal-title":"Brain Sci"},{"key":"B8","volume-title":"Neuroscience: Exploring the Brain. 4th edition","author":"Bear","year":"2016"},{"key":"B9","doi-asserted-by":"publisher","first-page":"71863","DOI":"10.1155\/2007\/71863","article-title":"Nessi: an EEG-controlled web browser for severely paralyzed patients","volume":"2007","author":"Bensch","year":"2007","journal-title":"Comput. Intell. Neurosci"},{"key":"B10","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1080\/01969727308546047","article-title":"Cluster validity with fuzzy sets","volume":"3","author":"Bezdek","year":"1973","journal-title":"J. Cybernet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/BF02339490","article-title":"Numerical taxonomy with fuzzy sets","volume":"1","author":"Bezdek","year":"1974","journal-title":"Math. Biol"},{"key":"B12","first-page":"143","article-title":"\u201cMathematical models for systematics and taxonomy,\u201d","author":"Bezdek","year":"1975","journal-title":"Proceedings of the 8th International Conference on Numerical Taxonomy"},{"key":"B13","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4757-0450-1","volume-title":"Pattern Recognition with Fuzzy Objective Function Algorithms. 1st edition","author":"Bezdek","year":"1981"},{"key":"B14","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1038\/18581","article-title":"A spelling device for the paralysed","volume":"398","author":"Birbaumer","year":"1999","journal-title":"Nature"},{"key":"B15","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1109\/86.847812","article-title":"The thought translation device (TTD) for completely paralyzed patients","volume":"8","author":"Birbaumer","year":"2000","journal-title":"IEEE Trans. Rehabil. Eng"},{"key":"B16","doi-asserted-by":"crossref","DOI":"10.1201\/b11148","volume-title":"Practical Biomedical Signal Analysis Using MATLAB","author":"Blinowska","year":"2011"},{"key":"B17","doi-asserted-by":"publisher","first-page":"14432","DOI":"10.1073\/pnas.1308285110","article-title":"Surge of neurophysiological coherence and connectivity in the dying brain","volume":"110","author":"Borjigin","year":"2013","journal-title":"Proc. Natl. Acad. Sci. U. S. A"},{"key":"B18","doi-asserted-by":"publisher","first-page":"14037","DOI":"10.1038\/s41598-020-70447-7","article-title":"Brain-scale cortico-cortical functional connectivity in the delta-theta band is a robust signature of conscious states: an intracranial and scalp EEG study","volume":"10","author":"Bourdillon","year":"2020","journal-title":"Sci. Rep"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.12688\/f1000research.6590.1","article-title":"Combining complexity measures of EEG data: multiplying measures reveal previously hidden information","volume":"4","author":"Burns","year":"2015","journal-title":"F1000Research"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/03610917408548446","article-title":"A dendrite method for cluster analysis","volume":"3","author":"Calinski","year":"1974","journal-title":"Commun. Statis"},{"key":"B21","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/S0022-510X(99)00210-5","article-title":"The alsfrs-r: a revised als functional rating scale that incorporates assessments of respiratory function","volume":"169","author":"Cedarbaum","year":"1999","journal-title":"J. Neurol. Sci"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1038\/s41467-022-28859-8","article-title":"Spelling interface using intracortical signals in a completely locked-in patient enabled via auditory neurofeedback training","volume":"13","author":"Chaudhary","year":"2022","journal-title":"Nat Commun"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2120","DOI":"10.1093\/brain\/awx163","article-title":"Brain networks predict metabolism, diagnosis and prognosis at the bedside in disorders of consciousness","volume":"140","author":"Chennu","year":"2017","journal-title":"Brain"},{"key":"B24","doi-asserted-by":"publisher","first-page":"267","DOI":"10.3233\/IFS-1994-2306","article-title":"Fuzzy model identification based on cluster estimation","volume":"2","author":"Chiu","year":"1994","journal-title":"J. Intell. Fuzzy Syst"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e73691","DOI":"10.1371\/journal.pone.0073691","article-title":"A comparison of two spelling brain-computer interfaces based on visual P3 and SSVEP in locked-in syndrome","volume":"8","author":"Combaz","year":"2013","journal-title":"PLoS ONE"},{"key":"B26","doi-asserted-by":"publisher","first-page":"zsx024","DOI":"10.1093\/sleep\/zsx024","article-title":"Eeg functional connectivity prior to sleepwalking: Evidence of interplay between sleep and wakefulness","volume":"40","author":"Desjardins","year":"2017","journal-title":"Sleep"},{"key":"B27","doi-asserted-by":"publisher","first-page":"645","DOI":"10.3389\/fnins.2018.00645","article-title":"Do complexity measures of frontal EEG distinguish loss of consciousness in geriatric patients under anesthesia?","volume":"12","author":"Eagleman","year":"2018","journal-title":"Front. Neurosci"},{"key":"B28","doi-asserted-by":"publisher","first-page":"3179","DOI":"10.1093\/brain\/awy251","article-title":"Robust EEG-based cross-site and cross-protocol classification of states of consciousness","volume":"141","author":"Engemann","year":"2018","journal-title":"Brain"},{"key":"B29","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.tcs.2019.10.039","article-title":"Evaluating the numerical instability in fuzzy clustering validation of high-dimensional data","volume":"805","author":"Eustquio","year":"2020","journal-title":"Theor. Comput. Sci"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e1480","DOI":"10.1002\/wics.1480","article-title":"Soft clustering","volume":"12","author":"Ferraro","year":"2020","journal-title":"WIREs Comput. Statis"},{"key":"B31","author":"Gazzaniga","year":"2018","journal-title":"Cognitive Neuroscience: The Biology of the Mind"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2020","DOI":"10.1016\/j.apmr.2004.02.033","article-title":"The jfk coma recovery scale-revised: Measurement characteristics and diagnostic utility11no commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated","volume":"85","author":"Giacino","year":"2004","journal-title":"Arch. Phys. Med. Rehabil"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2157","DOI":"10.1016\/j.clinph.2011.03.022","article-title":"Determination of awareness in patients with severe brain injury using EEG power spectral analysis","volume":"122","author":"Goldfine","year":"2011","journal-title":"Clini. Neurophysiol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"48","DOI":"10.2478\/slgr-2013-0031","article-title":"Poincar\u00e9 plots in analysis of selected biomedical signals","volume":"35","author":"Goli\u0144ska","year":"2013","journal-title":"Stud. Logic Grammar Rethoric"},{"key":"B35","doi-asserted-by":"publisher","first-page":"102471","DOI":"10.1016\/j.nicl.2020.102471","article-title":"Assessing the state of consciousness for individual patients using complex, statistical stimuli","volume":"29","author":"G\u00f3rska","year":"2021","journal-title":"NeuroImage: Clini"},{"key":"B36","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.annfar.2013.11.002","article-title":"Assessing consciousness in coma and related states using transcranial magnetic stimulation combined with electroencephalography","volume":"33","author":"Gosseries","year":"2014","journal-title":"Annales Franaises d'Anesthsie et de Ranimation"},{"key":"B37","doi-asserted-by":"publisher","first-page":"251","DOI":"10.3389\/fnins.2017.00251","article-title":"Complete locked-in and locked-in patients: Command following assessment and communication with vibro-tactile P300 and motor imagery brain-computer interface tools","volume":"11","author":"Guger","year":"2017","journal-title":"Front. Neurol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.clinph.2014.04.019","article-title":"Poincar\u00e9 analysis of the electroencephalogram during sevoflurane anesthesia","volume":"126","author":"Hayashi","year":"2014","journal-title":"Clini. Neurophysiol"},{"key":"B39","first-page":"603","article-title":"\u201cThe thought translation device: structure of a multimodal brain-computer communication system,\u201d","volume-title":"First International IEEE EMBS Conference on Neural Engineering","author":"Hinterberger","year":"2003"},{"key":"B40","doi-asserted-by":"publisher","first-page":"8894","DOI":"10.1101\/450270","article-title":"EEG functional connectivity metrics wPLI and wSMI account for distinct types of brain functional interactions","volume":"2019","author":"Imperatori","year":"2019","journal-title":"Sci. Rep"},{"key":"B41","doi-asserted-by":"publisher","first-page":"2344","DOI":"10.1007\/s10439-014-1085-6","article-title":"A low computational cost algorithm for REM sleep detection using single channel EEG","volume":"42","author":"Imtiaz","year":"2014","journal-title":"Ann. Biomed. Eng"},{"key":"B42","doi-asserted-by":"publisher","first-page":"987","DOI":"10.3389\/fnins.2020.555093","article-title":"Electrophysiological and neuroimaging studies during resting state and sensory stimulation in disorders of consciousness: a review","volume":"14","author":"Jain","year":"2020","journal-title":"Front. Neurosci"},{"key":"B43","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1038\/s41597-020-00789-4","article-title":"A dataset of EEG and EOG from an auditory EOG-based communication system for patients in locked-in state","volume":"8","author":"Jaramillo-Gonzalez","year":"2021","journal-title":"Sci Data"},{"key":"B44","first-page":"371","article-title":"The ten-twenty electrode system of the international federation","volume":"10","author":"Jasper","year":"1958","journal-title":"Electroenceph. Clin. Neurophysiol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"987","DOI":"10.3390\/s19050987","article-title":"Removal of artifacts from EEG signals: a review","volume":"19","author":"Jiang","year":"2019","journal-title":"Sensors"},{"key":"B46","doi-asserted-by":"publisher","first-page":"3475","DOI":"10.1002\/hbm.20771","article-title":"A comparison of granger causality and coherency in fMRI-based analysis of the motor system","volume":"30","author":"Kayser","year":"2009","journal-title":"Hum. Brain Mapp"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.1097\/00001756-199806010-00007","article-title":"Restoration of neural output from a paralyzed patient by a direct brain connection","volume":"9","author":"Kennedy","year":"1998","journal-title":"Neuroreport"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1914","DOI":"10.1016\/j.cub.2013.07.075","article-title":"Information sharing in the brain indexes consciousness in non-communicative patients","volume":"23","author":"King","year":"2013","journal-title":"Curr. Biol"},{"key":"B49","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s12152-019-09409-4","article-title":"The history of BCI: From a vision for the future to real support for personhood in people with locked-in syndrome","volume":"13","author":"K\u00fcbler","year":"2020","journal-title":"Neuroethics"},{"key":"B50","doi-asserted-by":"publisher","first-page":"2658","DOI":"10.1016\/j.clinph.2008.06.019","article-title":"Braincomputer interfaces and communication in paralysis: extinction of goal directed thinking in completely paralysed patients?","volume":"119","author":"K\u00fcbler","year":"2008","journal-title":"Clini. Neurophysiol"},{"key":"B51","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1111\/j.1749-6632.2008.04122.x","article-title":"A brain-computer interface controlled auditory event-related potential (P300) spelling system for locked-in patients","volume":"1157","author":"K\u00fcbler","year":"2009","journal-title":"Ann. N. Y. Acad. Sci"},{"key":"B52","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1037\/0033-2909.127.3.358","article-title":"Brain-computer communication: Unlocking the locked in","volume":"127","author":"K\u00fcbler","year":"2001","journal-title":"Psychol. Bull"},{"key":"B53","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1016\/S0079-6123(05)50034-7","article-title":"The locked-in syndrome : what is it like to be conscious but paralyzed and voiceless?","volume":"150","author":"Laureys","year":"2005","journal-title":"Prog Brain Res"},{"key":"B54","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1098\/rsta.2014.0117","article-title":"Assessing levels of consciousness with symbolic analysis","volume":"373","author":"Lee","year":"2015","journal-title":"Phil. Trans. R. Soc. A"},{"key":"B55","first-page":"41","article-title":"Resting-state eeg study of comatose patients: a connectivity and frequency analysis to find differences between vegetative and minimally conscious states","volume":"27","author":"Lehembre","year":"2012","journal-title":"Funct. Neurol"},{"key":"B56","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1109\/TIT.1976.1055501","article-title":"On the complexity of finite sequences","volume":"22","author":"Lempel","year":"1976","journal-title":"IEEE Trans. Inform. Theory"},{"key":"B57","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1051\/medsci\/20153110017","article-title":"Interfaces cerveau-ordinateur, locked-in syndrome et troubles de la conscience","volume":"31","author":"Lesenfants","year":"2015","journal-title":"Med. Sci"},{"key":"B58","doi-asserted-by":"publisher","first-page":"035002","DOI":"10.1088\/1741-2560\/11\/3\/035002","article-title":"An independent SSVEP-based braininterface in locked-in syndrome","volume":"11","author":"Lesenfants","year":"2014","journal-title":"J. Neural Eng"},{"key":"B59","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1177\/1550059413505533","article-title":"A vibrotactile P300-based brain-computer interface for consciousness detection and communication","volume":"45","author":"Lugo","year":"2014","journal-title":"Clin. EEG Neurosci"},{"key":"B60","doi-asserted-by":"crossref","DOI":"10.1002\/0471721182","volume-title":"Finite Mixture Models","author":"McLachlan","year":"2000"},{"key":"B61","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1016\/j.clinph.2010.08.019","article-title":"Transition from the locked in to the completely locked-in state: a physiological analysis","volume":"122","author":"Murguialday","year":"2011","journal-title":"Clini. Neurophysiol"},{"key":"B62","unstructured":"What is Locked-in Syndrome\n          \n          1995"},{"key":"B63","first-page":"167","article-title":"\u201cThe normal EEG of the waking adult,\u201d","author":"Niedermeyer","year":"2005","journal-title":"Electroencephalography: Basic principles, Clinical applications, and related Fields, Fifth edition"},{"key":"B64","unstructured":"NINDS\n          \n          \n          Amyotrophic Lateral Sclerosis (ALS) Fact Sheet\n          \n          2013"},{"key":"B65","doi-asserted-by":"publisher","first-page":"2292","DOI":"10.1016\/j.clinph.2004.04.029","article-title":"Identifying true brain interaction from EEG data using the imaginary part of coherency","volume":"115","author":"Nolte","year":"2004","journal-title":"Clini. Neurophysiol"},{"key":"B66","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1177\/1545968313516867","article-title":"Brain-computer interface with language model-electroencephalography fusion for locked-in syndrome","volume":"28","author":"Oken","year":"2014","journal-title":"Neurorehabil. Neural Repair"},{"key":"B67","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1093\/bja\/aev095","article-title":"Electroencephalographic coherence and cortical acetylcholine during ketamine-induced unconsciousness","volume":"114","author":"Pal","year":"2015","journal-title":"Br. J. Anaesth"},{"key":"B68","doi-asserted-by":"publisher","first-page":"056007","DOI":"10.1088\/1741-2560\/11\/5\/056007","article-title":"Detecting awareness in patients with disorders of consciousness using a hybrid brain-computer interface","volume":"11","author":"Pan","year":"2014","journal-title":"J. Neural Eng"},{"key":"B69","volume-title":"The Official Patient's Sourcebook on Locked-In Syndrome: A Revised and Updated Directory for the Internet Age","author":"Parker","year":"2004"},{"key":"B70","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1001\/archneur.63.4.562","article-title":"Brain response to one's own name in vegetative state, minimally conscious state, and locked-in syndrome","volume":"63","author":"Perrin","year":"2006","journal-title":"Arch. Neurol"},{"key":"B71","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.ijar.2012.10.003","article-title":"Soft clustering fuzzy and rough approaches and their extensions and derivatives","volume":"54","author":"Peters","year":"2013","journal-title":"Int. J. Approxim. Reason"},{"key":"B72","volume-title":"Plum and Posner's Diagnosis of Stupor and Coma","author":"Posner","year":"2007"},{"key":"B73","volume-title":"Spectral Analysis and Time Series, Two-Volume Set: Volumes I and II","author":"Priestley","year":"1981"},{"key":"B74","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1097\/ALN.0000000000003398","article-title":"Granger causality of the electroencephalogram reveals abrupt global loss of cortical information flow during propofol-induced loss of responsiveness","volume":"133","author":"Pullon","year":"2020","journal-title":"Anesthesiology"},{"key":"B75","doi-asserted-by":"publisher","first-page":"S12","DOI":"10.1097\/00000542-198009001-00012","article-title":"Spectral edge frequency - a new correlate of anesthetic depth","volume":"53","author":"Rampil","year":"1980","journal-title":"Anesthesiology"},{"key":"B76","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s13023-015-0304-z","article-title":"Quality of life in patients with locked-in syndrome: Evolution over a 6-year period","volume":"19","author":"Rousseau","year":"2015","journal-title":"Orphanet J. Rare Dis"},{"key":"B77","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3389\/fninf.2016.00005","article-title":"Connectivity measures in EEG microstructural sleep elements","volume":"10","author":"Sakellariou","year":"2016","journal-title":"Front. Neuroinform"},{"key":"B78","doi-asserted-by":"publisher","first-page":"116","DOI":"10.3389\/fphys.2019.00116","article-title":"The application of the extended poincar\u00e9 plot in the analysis of physiological variabilities","volume":"10","author":"Satti","year":"2019","journal-title":"Front. Physiol"},{"key":"B79","doi-asserted-by":"publisher","first-page":"e0133532","DOI":"10.1371\/journal.pone.0133532","article-title":"Complexity of multi-dimensional spontaneous EEG decreases during propofol induced general anaesthesia","volume":"10","author":"Schartner","year":"2015","journal-title":"PLoS ONE"},{"key":"B80","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1080\/13554790902724904","article-title":"Detecting consciousness in a total locked-in syndrome: An active event-related paradigm","volume":"15","author":"Schnakers","year":"2009","journal-title":"Neurocase"},{"key":"B81","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1177\/17562864231160873","article-title":"Locked-in syndrome revisited","volume":"29","author":"Schnetzer","year":"2023","journal-title":"Ther. Adv. Neurol. Disord"},{"key":"B82","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1007\/s11571-020-09639-w","article-title":"EEG power spectral density in locked-in and completely locked-in state patients: a longitudinal study","volume":"15","author":"Secco","year":"2021","journal-title":"Cogn. Neurodyn"},{"key":"B83","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.nicl.2016.12.004","article-title":"Multidimensional cognitive evaluation of patients with disorders of consciousness using EEG: a proof of concept study","volume":"13","author":"Sergent","year":"2017","journal-title":"NeuroImage. Clinical"},{"key":"B84","doi-asserted-by":"publisher","first-page":"951","DOI":"10.5664\/jcsm.3002","article-title":"Fragmentation of slow wave sleep after onset of complete locked-in state","volume":"9","author":"Soekadar","year":"2013","journal-title":"J. Clini. Sleep Med"},{"key":"B85","doi-asserted-by":"publisher","first-page":"72","DOI":"10.2307\/1412159","article-title":"The proof and measurement of association between two things","volume":"15","author":"Spearman","year":"1904","journal-title":"Am. J. Psychol"},{"key":"B86","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1002\/wics.1204","article-title":"Model-based cluster analysis","volume":"4","author":"Stahl","year":"2012","journal-title":"WIREs Comput. Statist"},{"key":"B87","volume-title":"Spectral Analysis of Signals","author":"Stoica","year":"2005"},{"key":"B88","doi-asserted-by":"publisher","first-page":"8452","DOI":"10.1038\/s41598-020-65333-1","article-title":"Auditory electrooculogram-based communication system for ALS patients in transition from locked-in to complete locked-in state","volume":"10","author":"Tonin","year":"2020","journal-title":"Sci Reports"},{"key":"B89","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1016\/j.clinph.2019.05.014","article-title":"EEG power spectral density under propofol and its association with burst suppression, a marker of cerebral fragility","volume":"130","author":"Touchard","year":"2019","journal-title":"Clini. Neurophysiol"},{"key":"B90","doi-asserted-by":"publisher","first-page":"2060","DOI":"10.1056\/NEJMoa1608085","article-title":"Fully implanted braincomputer interface in a locked-in patient with ALS","volume":"375","author":"Vansteensel","year":"2016","journal-title":"N. Engl. J. Med"},{"key":"B91","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/brainsci14010092","article-title":"Update on how to approach a patient with locked-in syndrome and their communication ability","volume":"14","author":"Voity","year":"2024","journal-title":"Brain Sci"},{"key":"B92","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1007\/s11571-014-9325-x","article-title":"Power spectral density and coherence analysis of alzheimers EEG","volume":"9","author":"Wang","year":"2015","journal-title":"Cogn. Neurodyn"},{"key":"B93","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1109\/TAU.1967.1161901","article-title":"The use of fast fourier transform for the estimation of power spectra: a method based on time averaging over short, modified periodograms","volume":"15","author":"Welch","year":"1967","journal-title":"IEEE Trans. Audio Electroacoust"},{"key":"B94","doi-asserted-by":"publisher","first-page":"e613","DOI":"10.1212\/WNL.0000000000207474","article-title":"Global prevalence and incidence of amyotrophic lateral sclerosis, a systematic review","volume":"8","author":"Wolfson","year":"2023","journal-title":"Neurology"},{"key":"B95","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1007\/s00415-019-09652-y","article-title":"Global variation in prevalence and incidence of amyotrophic lateral sclerosis: a systematic review and meta-analysis","volume":"267","author":"Xu","year":"2020","journal-title":"J. Neurol"},{"key":"B96","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/j.clinph.2010.05.036","article-title":"Application of nonlinear dynamics analysis in assessing unconsciousness: a preliminary study","volume":"122","author":"yu Wu","year":"2011","journal-title":"Clini. Neurophysiol"},{"key":"B97","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.neulet.2017.06.013","article-title":"Coherence in P300 as a predictor for the recovery from disorders of consciousness","volume":"653","author":"Zhang","year":"2017","journal-title":"Neurosci. Lett"}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2025.1604173\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T05:24:30Z","timestamp":1757568270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2025.1604173\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":97,"alternative-id":["10.3389\/fnins.2025.1604173"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2025.1604173","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,11]]},"article-number":"1604173"}}