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Aim Deep brain stimulation (DBS) is a potential neuromodulatory therapy that enhances recovery from disorders of consciousness, especially minimally conscious state (MCS). This study measured the effects of DBS on the brain and explored the underlying mechanisms of DBS on MCS. Methods Nine patients with MCS were recruited for this study. The neuromodulation effects of 100 Hz DBS were explored via cross‐control experiments. Coma Recovery Scale‐Revised (CRS‐R) and EEG were recorded, and corresponding functional connectivity and network parameters were calculated. Results Our results showed that 100 Hz DBS could improve the functional connectivity of the whole, local and local–local brain regions, while no significant change in EEG functional connectivity was observed in sham DBS. The whole brain's network parameters (clustering coefficient, path length, and small world characteristic) were significantly improved. In addition, a significant increase in the CRS‐R and functional connectivity of three MCS patients who received 100 Hz DBS for 6 months were observed. Conclusion This study showed that DBS improved EEG functional connectivity and brain networks, indicating that the long‐term use of DBS could improve the level of consciousness of MCS patients. Study design.

[This corrects the article DOI: 10.3389/fnins.2025.1610811.].

Background Respiratory variability (RV) reflects the dynamic modulation of breathing patterns by the central nervous system and may serve as a physiological marker of consciousness. However, its predictive value in disorders of consciousness (DOC) remains unclear. Objective To investigate the relationship between RV and the level of consciousness, and to evaluate the potential of RV‐based analysis for predicting clinical outcomes in DOC patients. Methods Patients with disorders of consciousness and healthy controls were assessed using inertial measurement unit (IMU) sensors to record triaxial acceleration signals. RV indicators were extracted from respiratory waveforms. A generalized additive model (GAM) was applied to adjust for confounding variables. Group differences were evaluated using Bootstrap resampling and the Mann–Whitney U test. Machine learning models—including random forest, elastic net, support vector machine, and partial least squares regression—were employed to predict Coma Recovery Scale–Revised (CRS‐R) scores and clinical outcomes. Results Significant differences in multiple RV indicators were observed between patient and control groups (p < 0.05), indicating an association between RV and the pathophysiology of consciousness disorders. Among the tested models, the random forest algorithm achieved the best predictive performance for CRS‐R scores (mean squared error = 3.76, R2 = 0.76) and for clinical outcomes (AUC = 0.74, sensitivity = 0.86), outperforming other models. Conclusions Respiratory variability, particularly when analyzed via random forest modeling, shows strong potential for prognostic assessment and clinical decision support in disorders of consciousness. RV may represent a non‐invasive biomarker reflecting the neural control of respiration and consciousness state. Respiratory variability (RV) was analyzed in patients with consciousness disorders and healthy controls. Significant RV differences were found, with random forest models outperforming others in predicting clinical outcomes.

Background Patients with disorders of consciousness (DOC) undergoing spinal cord stimulation (SCS) for arousal treatment require an assessment of their conscious state before and after the procedure. This is typically evaluated using behavioral scales (CRS‐R), but this method can be influenced by the subjectivity of the physician. Event‐related potentials (ERP) and EEG power spectrum are associated with the recovery of consciousness. This study aims to explore the electrophysiological and behavioral evidence of consciousness recovery in DOC patients after spinal cord stimulation (SCS) and to investigate the role of scalp EEG as a guide for preoperative assessment related to the surgery. Methods For the 27 recruited patients, the CRS‐R scale assessment and ERP P300 evaluation were completed before the surgery. At 3 months post‐surgery, all 27 patients underwent the same assessments as preoperatively, and at 6 months post‐surgery, the same evaluations were repeated for the 15 patients who could still be followed up. Between May 2023 and November 2023, resting‐state EEG was collected from 13 patients using a 19‐channel setup, with additional resting‐state EEG recordings taken at 3 months and 6 months after the surgery. The EEG data were processed using EEGLAB to obtain P300‐related metrics and EEG power spectrum. Changes in the CRS‐R scale, ERP, and EEG power spectrum before and after the surgery were compared. Results The Behavioral Scale (CRS‐R) showed significant improvement at 3 months and 6 months post‐surgery compared to preoperative assessments, with statistical significance (p < 0.001). The resting‐state EEG power in the 5–9 Hz frequency band demonstrated statistically significant improvements at the P3 and O1 electrodes; however, this statistical result do not survive FDR correction. In the 9–13 Hz and 20–35 Hz frequency bands, the power spectrum showed statistically significant improvements across most electrodes of the brain, and these results survive FDR correction (p < 0.05). The mean amplitude, peak, and latency of P300 at the Pz electrode showed significant improvements at 3 months and 6 months post‐surgery compared to preoperative values, with statistical significance (p < 0.05). Conclusion Our study shows that SCS can effectively improve the consciousness states of patients with DOC. After surgery, there were positive changes in the EEG power spectrum of the patients, transitioning from type “B” to better types “C” and “D.” The average amplitude, peak, and latency of P300 also demonstrated significant improvements postoperatively. We believe that the “ABCD” model and ERP assessment applied during the preoperative evaluation can effectively enhance the success rate of SCS surgery in promoting awakening. Our study indicates that spinal cord stimulation improves consciousness in DOC patients, shown by EEG changes and enhanced P300 metrics. The “ABCD” model and ERP assessments may boost SCS surgery success rates for awakening.

•Short-term and Long-term Effects: The study demonstrated that short-term SCS did not immediately alter the CRS-R scores, while long-term SCS led to significant improvements in the CRS-R scores for all patients, indicating the potential long-term benefits of SCS in DOC patients.•Neural Connectivity Changes: The EEG results revealed significant changes in Genuine Permutation Cross Mutual Information (G_PCMI) in the frontal and central brain regions before and after short-term SCS, as well as significant differences in PCMI of specific brain regions, highlighting the impact of SCS on cortical connectivity.•Correlation with Behavioral Changes: The study found a significant positive correlation between changes in G_PCMI in specific brain regions and CRS-R changes, suggesting a link between neural connectivity changes and behavioral improvements in DOC patients undergoing SCS treatment.•Clinical Implications: The findings suggest that SCS has the potential to improve the awareness level of DOC patients and enhance both short- and long-distance cortical connectivity, thereby contributing to the improvement of consciousness levels. Spinal cord stimulation (SCS) is an advanced neuromodulation technology in disorders of consciousness (DOC) field. However, research on the modulation effects and mechanisms of SCS is limited. We proposed a study design (SCS and sham) to study the short-term effects of 20 minutes’ SCS, in which resting state EEG and Coma Recovery Scale-Revised (CRS-R) were used to measure the changes in neural and behavioral activity caused by SCS. We used the Genuine Permutation Cross Mutual Information(G_PCMI) to analyze EEG data and study changes in cortical connectivity during SCS. Finally, all patients’ CRS-R results were obtained after 6 months’ SCS treatment. Short-term SCS (20 min) did not alter the patient's CRS-R score, but long-term SCS (6 months) can improve the CRS-R scores of all patients. EEG results show G_PCMI of the frontal and central brain regions significantly change before and after short-term SCS (p < 0.01) and PCMI of the F-P, F-O regions have significant differences before and after short-term SCS (p < 0.05). Besides, the G_PCMI changes in frontal, parietal, F-P and F-O regions show a significant positive correlation with CRS-R changes (r = 0.80, 0.66, 0.68 and 0.72; p < 0.05). However, the sham group showed no significant G_PCMI changes. SCS can improve the awareness level of DOC patients. SCS improves cortical short- and long-distance connectivity of DOC patients may contribute the improvement of consciousness level.

Musical sensory orientation training (MSOT) is an innovative technique to improve the state of consciousness and cognitive function. Compared with traditional arousal therapies, MSOT offers a non-invasive, safe, and easily operable alternative with no side effects. This study aimed to conduct a preliminary investigation into the effect of MSOT in improving consciousness levels in patients with DoC (Disorders of Consciousness), as well as the feasibility of its clinical application, thereby providing reference for future large-sample randomized controlled studies. We recruited 42 participants between March 2024 to March 2025, dividing them into two groups: a control group of 21 patients who received conventional treatment for DoC and watched videos of family/friends' activities and short videos, and an intervention group of 21 patients who received MSOT along with conventional treatment. Patients in both groups were assessed at baseline, week 5 and week 8 of the intervention. The MSOT group showed significant improvement in Coma Recovery Scale-Revised (CRS-R) subscale and total scores over time (baseline, week 5, week 8). At week 8, the MSOT group demonstrated significantly higher CRS-R scores in communication function and arousal level compared to the control group. Behavioral observations in the MSOT group revealed significantly higher frequencies of name response, sound source tracking, and command-following behaviors. The results of this study demonstrate that MSOT exhibits certain effect in improving consciousness levels in patients with DoC and demonstrates feasibility in clinical implementation. Extending the intervention duration in future studies may amplify its therapeutic effects.

Background The Coma Recovery Scale-Revised (CRS-R) has become a standard tool in assessing Disorders of consciousness (DoC) in adults. However, its measurement validity in pediatrics has only been ascertained in healthy cases. Increasing use of CRS-R in children with DoC imposes appropriate comparison against previously validated tools. The aims of the study were to describe the emergence to a conscious state (eMCS) in pediatric acquired brain injury (ABI); to explore the agreement between the CRS-R and Coma Near Coma Scale (CNCS) and to discuss the advantage of administering the CRS-R in pediatric age. Materials and methods In this observational prospective study, 40 patients were recruited. Inclusion criteria were age 5 to 18 years, Glasgow Coma Scale (GCS) score ≤ 8 at the insult, and unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) at admission. Patients were assessed with CRS-R, and CNCS was used as standard. Results The agreement between scales was moderate ( r  = − 0.71). The analysis of the CRS-R domain scores also confirmed that decreasing CNCS levels (from a coma to eMCS) corresponded to concurrent increas of CRS-R scores in all domains. Moreover, CRS-R better defined patients’ status in the emergency phase from MCS. Conversely, CRS-R had lower DoC scoring ability in the presence of severe motor impairment. Conclusion We show that CRS-R can track changes in DoC in children as young as 5 years old, and we provide evidence that the agreement with CNCS scores is good.

This study aimed to explore differences in sleep electroencephalogram (EEG) patterns in individuals with prolonged disorders of consciousness, utilizing polysomnography (PSG) to assist in distinguishing between the vegetative state (VS)/unresponsive wakefulness syndrome (UWS) and the minimally conscious state (MCS), thereby reducing misdiagnosis rates and enhancing the quality of medical treatment. A total of 40 patients with prolonged disorders of consciousness (pDOC; 27 patients in the VS/UWS and 13 in the MCS) underwent polysomnography. We analyzed differential EEG indices between VS/UWS and MCS groups and performed correlation analyses between these indices and the Coma Recovery Scale-Revised (CRS-R) scores. The diagnostic accuracy of the differential indices was evaluated using receiver operating characteristic (ROC) curves. 1. The fractal dimension (Higuchi's fractal dimension (HFD)) of patients in the MCS tended to be higher than that of patients in the VS/UWS across all phases, with a significant difference only in the waking phase ( < 0.05). The HFD in the waking phase was positively correlated with the CRS-R score and exhibited the highest diagnostic accuracy at 88.3%. The Teager-Kaiser energy operator (TKEO) also showed higher levels in patients in the MCS compared to those in the VS/UWS, significantly so in the NREM2 phase ( < 0.05), with a positive correlation with the CRS-R score and diagnostic accuracy of 75.2%. The -band power spectral density [PSD(δ)] in the patients in the MCS was lower than that in those in the VS/UWS, significantly so in the waking phase ( < 0.05), and it was negatively correlated with the CRS-R score, with diagnostic accuracy of 71.5%. Polysomnography for the VS/UWS and MCS revealed significant differences, aiding in distinguishing between the two patient categories and reducing misdiagnosis rates. Notably, the HFD and PSD( ) showed significantly better performance during wakefulness compared to sleep, while the TKEO was more prominent in the NREM2 stage. Notably, the HFD exhibited a robust correlation with the CRS-R scores, the highest diagnostic accuracy, and immense promise in the clinical diagnosis of prolonged disorders of consciousness.

The temperature of the brain can reflect the activity of its different regions, allowing us to evaluate the connections between them. A study involving 111 patients in a vegetative state or minimally conscious state used microwave radiometry to measure their cortical temperature. The patients were divided into a main group receiving a 10-day selective craniocerebral hypothermia (SCCH) procedure, and a control group receiving basic therapy and rehabilitation. The main group showed a significant improvement in consciousness level as measured by CRS-R assessment on day 14 compared to the control group. Temperature heterogeneity increased in patients who received SCCH, while remaining stable in the control group. The use of microwave radiometry to assess rehabilitation effectiveness and the inclusion of SCCH in rehabilitation programs appears to be a promising approach.

Patients suffering from disorders of consciousness still present a diagnostic challenge due to the fact that their assessment is mainly based on behavioral scales with their motor responses often being strongly impaired. We therefore focused on resting electroencephalography (EEG) in order to reveal potential alternative measures of the patient’s current state independent of rather complex abilities (e.g., language comprehension). Resting EEG was recorded in nine minimally conscious state (MCS) and eight vegetative state/unresponsive wakefulness syndrome (VS/UWS) patients. Behavioral assessments were conducted using the Coma-Recovery Scale—Revised (CRS-R). The signal was analyzed in the frequency domain and association between resting EEG and CRS-R score as well as clinical diagnosis were calculated using Pearson correlation and repeated-measures ANOVAs. The analyses revealed robust positive correlations between CRS-R score and ratios between frequencies above 8 Hz and frequencies below 8 Hz. Furthermore, the frequency of the spectral peak was also highly indicative of the patient’s CRS-R score. Concerning differences between clinical diagnosis and healthy controls, it could be revealed that while VS/UWS patients showed higher delta and theta activity than controls, MCS did not differ from controls in this frequency range. Alpha activity, on the other hand, was strongly decreased in both patient groups as compared to controls. The strong relationship between various resting EEG parameters and CRS-R score provides significant clinical relevance. Not only is resting activity easily acquired at bedside, but furthermore, it does not depend on explicit cooperation of the patient. Especially in cases where behavioral assessment is difficult or ambiguous, spectral analysis of resting EEG can therefore complement clinical diagnosis.