Objective:

To determine whether high-frequency rTMS of the left angular gyrus improves behavioral signs of consciousness in prolonged disorders of consciousness (pDoC) and to identify network mechanisms and predictors of response.

Approach:

Key Findings:

• Behavioral improvement occurred more frequently during active than sham stimulation (p < 0.05), mainly in visual, motor, and auditory domains.
• Post-rTMS recovery within the default mode network (DMN) and the subcortical network (SCN) characterized responders (random forest AUC = 0.861).
• Stronger baseline within-DMN functional connectivity predicted greater likelihood of improvement (support vector machine AUC = 0.972).

Interpretation:

Left angular gyrus rTMS improved consciousness-related behaviors in a subset of pDoC patients.

Limitations:

• The study's findings are based on a specific patient population and may not generalize to all pDoC patients.
• The sample size, while adequate for preliminary findings, may limit the robustness of the conclusions.

Conclusion:

Patients with stronger baseline within-DMN connectivity were more likely to show improvement.

Sources:

• Clinical Trial Registration
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