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Background: The management of patients with disorders of consciousness (DOC) presents substantial challenges in clinical practice. Deep brain stimulation (DBS) has emerged as a potential therapeutic approach, but the lack of standardized regulatory parameters for DBS in DOC hinders definitive conclusions. Objective: This comprehensive review aims to provide a detailed summary of the current issues concerning patient selection, target setting, and modulation parameters in clinical studies investigating the application of DBS for DOC patients. Methods: A meticulous systematic analysis of the literatures was conducted, encompassing articles published from 1968 to April 2023, retrieved from reputable databases (PubMed, Embase, Medline, and Web of Science). Results: The systematic analysis of 21 eligible articles, involving 146 patients with DOC resulting from acquired brain injury or other disorders, revealed significant insights. The most frequently targeted regions were the Centromedian‐parafascicular complex (CM‐pf) nuclei and central thalamus (CT), both recognized for their role in regulating consciousness. However, other targets have also been explored in different studies. The stimulation frequency was predominantly set at 25 or 100 Hz, with pulse width of 120 μs, and voltages ranged from 0 to 4 V. These parameters were customized based on individual patient responses and evaluations. The overall clinical efficacy rate in all included studies was 39.7%, indicating a positive effect of DBS in a subset of DOC patients. Nonetheless, the assessment methods, follow‐up durations, and outcome measures varied across studies, potentially contributing to the variability in reported efficacy rates. Conclusion: Despite the challenges arising from the lack of standardized parameters, DBS shows promising potential as a therapeutic option for patients with DOC. However, there still remains the need for standardized protocols and assessment methods, which are crucial to deepen the understanding and optimizing the therapeutic potential of DBS in this specific patient population. [ABSTRACT FROM AUTHOR]

Background: Accurately diagnosing patients with the vegetative state (VS) and the minimally conscious state (MCS) reached a misdiagnosis of approximately 40%. Methods: A method combined microstate and dynamic functional connectivity (dFC) to study the spatiotemporal variability of the brain in disorders of consciousness (DOC) patients was proposed. Resting‐state EEG data were obtained from 16 patients with MCS and 16 patients with VS. Mutual information (MI) was used to assess the EEG connectivity in each microstate. MI‐based features with statistical differences were selected as the total feature subset (TFS), then the TFS was utilized to feature selection and fed into the classifier, obtaining the optimal feature subsets (OFS) in each microstate. Subsequently, an OFS‐based MI functional connectivity network (MIFCN) was constructed in the cortex. Results: The group‐average MI connectivity matrix focused on all channels revealed that all five microstates exhibited stronger information interaction in the MCS when comparing with the VS. While OFS‐based MIFCN, which only focused on a few channels, revealed greater MI flow in VS patients than in MCS patients under microstates A, B, C, and E, except for microstate D. Additionally, the average classification accuracy of OFS in the five microstates was 96.2%. Conclusion: Constructing features based on microstates to distinguish between two categories of DOC patients had effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the prognostic effect of electroencephalography (EEG) instant effects of single spinal cord stimulation (SCS) on clinical outcome in disorders of consciousness (DOC) and the time‐dependent brain response during the recovery of consciousness prompted by SCS. Methods: Twenty three patients with DOC underwent short‐term SCS (stSCS) implantation operation. Then, all patients received the postoperative EEG test including EEG record before (T1) and after (T2) single SCS session. Subsequently, 2 weeks stSCS treatment was performed and revised coma recovery scale (CRS‐R) and EEG data were collected. Finally, they were classified into effective and ineffective groups at 3‐month follow‐up (T6). Results: The parietal‐occipital (PO) connectivity and clustering coefficients (CC) in the beta band of the effective group at the 1 week after the treatment (T5) were found to be higher than preoperative assessment (T0). Correlation analysis showed that the change in beta CC at T1/T2 was correlated with the change in CRS‐R at T0/T6. In addition, the change in PO connectivity and CC in the beta at T0/T5 were also correlated with the change in CRS‐R at T0/T5. Conclusion: SCS may facilitate the recovery of consciousness by enhancing local information interaction in posterior brain regions. And the recovery can be predicted by beta CC in the EEG test. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background and Objectives: The resting‐state brain is composed of several discrete networks, which remain stable for 10–100 ms. These functional microstates are considered the building blocks of spontaneous consciousness. Electroencephalography (EEG) microstate analysis may provide insight into the altered brain dynamics underlying consciousness recovery in patients with disorders of consciousness (DOC). We aimed to analyze microstates in the resting‐state EEG source space in patients with DOC, the relationship between state‐specific features and consciousness levels, and the corresponding patterns of microstates and functional networks. Methods: We obtained resting‐state EEG data from 84 patients with DOC (27 in a minimally conscious state [MCS] and 57 in a vegetative state [VS] or with unresponsive wakefulness syndrome). We conducted a microstate analysis of the resting‐state (EEG) source space and developed a state‐transition analysis protocol for patients with DOC. Results: We identified seven microstates with distinct spatial distributions of cortical activation. Multivariate pattern analyses revealed that different functional connectivity patterns were associated with source‐level microstates. There were significant differences in the microstate properties, including spatial activation patterns, temporal dynamics, state shifts, and connectivity construction, between the MCS and VS groups. Discussion: Our findings suggest that consciousness depends on complex dynamics within the brain and may originate from the anterior cortex. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of patients with disorders of consciousness (DoC) remains a challenging issue, and spinal cord stimulation (SCS) has been reported to be a promising treatment for DoC in some studies. Aims: This study explores the efficiency of SCS in treating patients with DoC at different consciousness levels, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) and the minimally conscious state (MCS) and summarizes and analyzes the long‐term effect and related factors of SCS in patients with DoC. Results: An overall positive outcome was reached in 35 of 110 patients (31.8%). Among patients with positive outcomes, the MCS group improved 45.53% more than VS/UWS group, and this difference was statistically significant. In terms of the recommendation standard, positive outcomes occurred in 33 patients (94.3%) in the highly recommended group and 2 patients (5.7%) in the weakly recommended group (p < 0.001). After adjustment for potential covariables, young age (age ≤ 19 years old) (p = 0.045) and MCS (p < 0.001) were significantly correlated with positive outcome. A nomogram based on age, state of consciousness, and pathogeny showed good predictive performance, with a c‐index of 0.794. The Hosmer–Lemeshow goodness‐of‐fit test showed that the model was well calibrated (χ2 = 3.846, p = 0.871). Conclusions: SCS is one of the most feasible treatments for patients with DoC, especially for patients with MCS. Younger age is significantly associated with better outcomes and could therefore serve as a basis for preoperative screening. However, more evidence‐based randomized controlled trials are needed to confirm the efficacy of the treatment. [ABSTRACT FROM AUTHOR]

Biomaterials and neurotrophic factors represent two promising strategies for spinal cord injury repair. In this study, a combinatorial approach combining the PLGA nerve conduits and the recombinant human neurotrophin-3 (rhNT3) was utilized in a spinal cord injury animal model. After complete transection of the thoracic cord in rats, rhNT3 was administered as a single dose to the host cord caudal to a 2-mm conduit. Axonal regrowth was enhanced, as indicated by immunostaining and neurofilament-positive area measurement. Neural regrowth was further demonstrated via the retrograde tracing across the lesion. The animals implanted with the PLGA scaffold and rhNT3 exhibited significantly improved performance in BBB rating scale and grid walk tests. These observations suggest that PLGA nerve conduits combined with exogenous NT3 may serve as an alternative therapeutic approach for spinal cord injury repair. © 2011 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2011. [ABSTRACT FROM AUTHOR]