Trial reportProceedings of the National Academy of Sciences of the United States of America2010
Breakdown in cortical effective connectivity during midazolam-induced loss of consciousness.
Trial report in Proceedings of the National Academy of Sciences of the United States of America, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06667869 (Sistema de monitorización multiparámetros Para sedación de Pacientes críticos en UCI), which is not on this map. Cited by 232 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Sistema de monitorización multiparámetros Para sedación de Pacientes críticos en UCI (ROMANTIC: multipaRameter mOnitoring systeM for sedAtion iNThe ICu)
Who cites it
232 citing papers in PubMed, 3 syntheses or guidelines pooled it, 571 citations in OpenAlex.
- Transcranial magnetic stimulation-evoked electroencephalography responses as biomarkers for epilepsy: A review of study design and outcomes.Human brain mapping · 2023Pooled it
- Managing disorders of consciousness: the role of electroencephalography.Journal of neurology · 2021Pooled it
- Brain network disintegration as a final common pathway for delirium: a systematic review and qualitative meta-analysis.NeuroImage. Clinical · 2019Pooled it
- Neural effects of TMS trains on the human prefrontal cortex.Scientific reports · 2023Trial
- Subgenual cingulate connectivity and hippocampal activation are related to MST therapeutic and adverse effects.Translational psychiatry · 2020Trial
- Modulation of simultaneously collected hemodynamic and electrophysiological functional connectivity by ketamine and midazolam.Human brain mapping · 2020Trial
- The effects of NMDA receptor blockade on TMS-evoked EEG potentials from prefrontal and parietal cortex.Scientific reports · 2020Trial
- Effects of antiepileptic drugs on cortical excitability in humans: A TMS-EMG and TMS-EEG study.Human brain mapping · 2019Trial
- Efficiency of Repetitive Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex in Disorders of Consciousness: A Randomized Sham-Controlled Study.Neural plasticity · 2019Trial
- Effects of 20 Hz Repetitive Transcranial Magnetic Stimulation on Disorders of Consciousness: A Resting-State Electroencephalography Study.Neural plasticity · 2018Trial
- TDCS modulates cortical excitability in patients with disorders of consciousness.NeuroImage. Clinical · 2017Trial
- Computational Depth of Anesthesia via Multiple Vital Signs Based on Artificial Neural Networks.BioMed research international · 2015Trial
- TMS-EEG signatures of GABAergic neurotransmission in the human cortex.The Journal of neuroscience : the official journal of the Society for Neuroscience · 2014Trial
- Directional connectivity between frontal and posterior brain regions is altered with increasing concentrations of propofol.PloS one · 2014Trial
- BOLD fMRI in infants under sedation: Comparing the impact of pentobarbital and propofol on auditory and language activation.Journal of magnetic resonance imaging : JMRI · 2013Trial
- Article
- Catecholamine modulation of frontal cortical ignition during wakefulness, sleep and anesthesia.National science review · 2026Article
- Integrating multidimensional nociceptive-related cortical features for unsupervised assessment of anesthesia states in rats.iScience · 2026Article
- Clinical utility and prospective of TMS-EEG: Updated review from an international expert group.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2026Review
- Distinct origins of human low and high alpha rhythms revealed by simultaneous EEG-SEEG.Communications biology · 2026Article
172 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 2 countries.
Funding
Abstract
By employing transcranial magnetic stimulation (TMS) in combination with high-density electroencephalography (EEG), we recently reported that cortical effective connectivity is disrupted during early non-rapid eye movement (NREM) sleep. This is a time when subjects, if awakened, may report little or no conscious content. We hypothesized that a similar breakdown of cortical effective connectivity may underlie loss of consciousness (LOC) induced by pharmacologic agents. Here, we tested this hypothesis by comparing EEG responses to TMS during wakefulness and LOC induced by the benzodiazepine midazolam. Unlike spontaneous sleep states, a subject's level of vigilance can be monitored repeatedly during pharmacological LOC. We found that, unlike during wakefulness, wherein TMS triggered responses in multiple cortical areas lasting for >300 ms, during midazolam-induced LOC, TMS-evoked activity was local and of shorter duration. Furthermore, a measure of the propagation of evoked cortical currents (significant current scattering, SCS) could reliably discriminate between consciousness and LOC. These results resemble those observed in early NREM sleep and suggest that a breakdown of cortical effective connectivity may be a common feature of conditions characterized by LOC. Moreover, these results suggest that it might be possible to use TMS-EEG to assess consciousness during anesthesia and in pathological conditions, such as coma, vegetative state, and minimally conscious state.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.