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IntroductionTherapeutic interventions for disorders of consciousness lack consistency; evidence supports non-invasive brain stimulation, but few studies assess neuromodulation in acute-to-subacute brain-injured patients. This study aims to validate the feasibility and assess the effect of a multi-session transcranial alternating current stimulation (tACS) intervention in subacute brain-injured patients on recovery of consciousness, related brain oscillations and brain network dynamics.Methods and analysesThe study is comprised of two phases: a validation phase (n=12) and a randomised controlled trial (n=138). Both phases will be conducted in medically stable brain-injured adult patients (traumatic brain injury and hypoxic-ischaemic encephalopathy), with a Glasgow Coma Scale score ≤12 after continuous sedation withdrawal. Recruitment will occur at the intensive care unit of a Level 1 Trauma Centre in Montreal, Quebec, Canada. The intervention includes a 20 min 10 Hz tACS at 1 mA intensity or a sham session over parieto-occipital cortical sites, repeated over five consecutive days. The current’s frequency targets alpha brain oscillations (8–13 Hz), known to be associated with consciousness. Resting-state electroencephalogram (EEG) will be recorded four times daily for five consecutive days: pre and post-intervention, at 60 and 120 min post-tACS. Two additional recordings will be included: 24 hours and 1-week post-protocol. Multimodal measures (blood samples, pupillometry, behavioural consciousness assessments (Coma Recovery Scale-revised), actigraphy measures) will be acquired from baseline up to 1 week after the stimulation. EEG signal analysis will focus on the alpha bandwidth (8–13 Hz) using spectral and functional network analyses. Phone assessments at 3, 6 and 12 months post-tACS, will measure long-term functional recovery, quality of life and caregivers’ burden.Ethics and disseminationEthical approval for this study has been granted by the Research Ethics Board of the CIUSSS du Nord-de-l’Île-de-Montréal (Project ID 2021–2279). The findings of this two-phase study will be submitted for publication in a peer-reviewed academic journal and submitted for presentation at conferences. The trial’s results will be published on a public trial registry database (ClinicalTrials.gov).Trial registration number NCT05833568.

IntroductionAcute pain levels following orthopaedic injury (eg, fracture) are a predictor of the onset of chronic pain, which affects nearly 50% of fracture patients and impairs functional recovery. Among current pharmacological treatments for acute pain, non-steroidal anti-inflammatory drugs have been associated with delayed bone healing, while opioids inhibit effective bone remodelling, increase the risk of pseudarthrosis and carry a high risk of addiction. In light of this, the development of new pain treatments is essential. Cannabidiol (CBD), a non-addictive and non-psychotropic cannabis component stands out as a potential therapeutic agent, given its analgesic and anti-inflammatory properties as well as its potential benefits for bone healing. This randomised controlled trial aims to investigate the effect of acute CBD treatment, compared with placebo, on patients’ self-reported pain, inflammation and well-being following a fracture injury.Methods and analysisThis is a triple-blind, randomised, placebo-controlled clinical trial. A total of 225 adults aged 18–70 years, who have suffered a long bone fracture and were treated at the Hôpital du Sacré-Coeur de Montréal, will be randomly assigned within 1 week to one of three treatment arms (25 mg or 50 mg of CBD or placebo) for 1 month. The primary outcome will be the difference in the pain score between groups at 1-month follow-up. Secondary outcomes will include measures of persistent pain, inflammation, opioid usage, quality of life, sleep quality, depression, anxiety, cognition and orthopaedic function. Data will be collected at baseline, 1-month and 3-month follow-ups.Ethics and disseminationThis study obtained a Health Canada licence for use of cannabis products. It has also been approved by Health Canada and the Research Ethics Board of the CIUSSS du Nord-de-l’Île-de-Montréal (Project ID 2025-2105). The findings will be published in a peer-reviewed journal and presented at local, national and international conferences. The trial’s results will be made publicly available on the ClinicalTrials.gov database.Trial registration number NCT06448923.

Purpose of Review The present topical review aims to summarize the literature to give an overview of the clinical utility of non-invasive brain stimulation (NIBS) techniques to manage insomnia symptoms and other sleep disturbances. Recent Findings Repetitive transcranial magnetic stimulation and transcranial electric stimulation techniques have shown potential to manage sleep disturbances, although studies with robust double-blind controlled designs and larger samples are warranted to better support their use. In addition, other techniques such as transcranial random noise stimulation or transcutaneous vagal nerve stimulation can be promising and merit attention in future research. Summary The application of NIBS in sleep disorders is promising, but it is still an emerging research domain which requires exhaustive characterization with state-of-the-art sleep architecture investigation techniques such as in-laboratory or at-home polysomnography.

Crucial clinical decisions in the acute-to-subacute stages of severe traumatic brain injury (sTBI) are mostly based on neurological exams and behavioral assessments. Although electroencephalography (EEG)-derived indices of consciousness show prognostic potential, their effectiveness in tracking individual recovery over time remains unclear. This study characterizes the longitudinal recovery of consciousness following sTBI, tracking EEG spectral power, and aperiodic exponent markers, considering sex, etiology, and age. Four medically stable, non-sedated sTBI patients were recruited 7–26 days post-injury, based on etiology (sTBI), age (M=30 years, SD=1.41 years), lesion severity (diffuse axonal injury). Behavioral responsiveness was assessed daily using the Coma Recovery Scale-Revised (CRS-R), alongside 5-min resting-state EEG for 6 days, with an additional recording a week later. Changes in power spectral distribution and the aperiodic component were observed over time, even within similar diagnostic categories. The aperiodic component exhibited a similar improvement trajectory to behavioral responsiveness, with a progressive flattening of the EEG slope in two individuals who recovered consciousness. In contrast, individuals whose CRS-R category remained static showed inconsistent fluctuations in the aperiodic component over time. Improvements in CRS-R scores were accompanied by changes in absolute power for theta, alpha, and beta frequency bands. However, the “ABCD” and Maximum Frequency Peak frameworks showed limitations and inconsistencies when compared to behavioral outcomes. This longitudinal within-subject design captured neurophysiological changes along patient-specific recovery trajectories, revealing substantial fluctuations within individual EEG markers, despite controlling for typical confounds like etiology, age, lesion severity, and sex. Combining spectral power and the aperiodic exponent may support the development of more dynamic and reliable markers to track changes in brain activity associated with consciousness recovery, potentially improving diagnostic accuracy, outcome prediction, and therapeutic interventions. Ethical approval for this study has been given by the Research Ethics Board of the CIUSSS du Nord-de-l’Île-de-Montréal (Project ID 2021-2279).