Frontiers in human neuroscience · 2026
Non-invasive neuroregulation techniques applied to patients with consciousness disorders: a narrative review.
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Cao Zhijie, Du Hongzhen, Zhou Yufeng, Mei Shutong, Xia Zhangyong, Wang Yang
Аннотация
BACKGROUND: Disorders of consciousness (DoC) following severe brain injury pose significant diagnostic and therapeutic challenges. This narrative review comprehensively examines the current evidence for neuromodulation techniques in promoting consciousness recovery, including their mechanisms, efficacy, and future directions.
METHODS: We conducted a narrative review of evidence from randomized controlled trials, meta-analyses, and pilot studies investigating non-invasive and minimally invasive neuromodulation techniques for DoC. PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched from inception through December 2025. Techniques reviewed include transcranial magnetic stimulation (TMS), transcranial electrical stimulation (tES), median nerve stimulation (MNS), transcutaneous auricular vagus nerve stimulation (taVNS), transcranial focused ultrasound (tFUS), acupuncture, and spinal cord stimulation (SCS).
RESULTS: High-frequency repetitive TMS (10-20 Hz) targeting the dorsolateral prefrontal cortex showed significant CRS-R improvements with sustained effects. Right MNS (8 h/day, 2 weeks) significantly increased consciousness recovery rates in acute traumatic brain injury (RR = 1.36, 95% CI 1.18-1.56). Anodal tDCS demonstrated modest benefits, particularly in MCS patients. taVNS improved consciousness in MCS but not UWS patients. Short-term SCS (70 Hz) produced sustained improvements, especially in MCS - patients. Preliminary tFUS studies targeting the thalamus showed promising results. Combined interventions exhibited synergistic effects. Treatment responses varied by consciousness level, etiology, and individual factors. Adverse events were minimal across modalities.
CONCLUSION: Emerging evidence suggests that neuromodulation may have therapeutic potential for DoC, with comparatively stronger support currently available for high-frequency rTMS, right MNS, and SCS. Future research should prioritize large-scale RCTs, predictive biomarker identification, personalized closed-loop protocols, and optimal combination strategies, with a gradual shift from deterministic to individualized treatment paradigmss.
METHODS: We conducted a narrative review of evidence from randomized controlled trials, meta-analyses, and pilot studies investigating non-invasive and minimally invasive neuromodulation techniques for DoC. PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched from inception through December 2025. Techniques reviewed include transcranial magnetic stimulation (TMS), transcranial electrical stimulation (tES), median nerve stimulation (MNS), transcutaneous auricular vagus nerve stimulation (taVNS), transcranial focused ultrasound (tFUS), acupuncture, and spinal cord stimulation (SCS).
RESULTS: High-frequency repetitive TMS (10-20 Hz) targeting the dorsolateral prefrontal cortex showed significant CRS-R improvements with sustained effects. Right MNS (8 h/day, 2 weeks) significantly increased consciousness recovery rates in acute traumatic brain injury (RR = 1.36, 95% CI 1.18-1.56). Anodal tDCS demonstrated modest benefits, particularly in MCS patients. taVNS improved consciousness in MCS but not UWS patients. Short-term SCS (70 Hz) produced sustained improvements, especially in MCS - patients. Preliminary tFUS studies targeting the thalamus showed promising results. Combined interventions exhibited synergistic effects. Treatment responses varied by consciousness level, etiology, and individual factors. Adverse events were minimal across modalities.
CONCLUSION: Emerging evidence suggests that neuromodulation may have therapeutic potential for DoC, with comparatively stronger support currently available for high-frequency rTMS, right MNS, and SCS. Future research should prioritize large-scale RCTs, predictive biomarker identification, personalized closed-loop protocols, and optimal combination strategies, with a gradual shift from deterministic to individualized treatment paradigmss.