Work

What are the neural networks that have been modulated by anatomically targeted therapies to promote recovery of consciousness? A scoping review

Year: 2026

Type: review

Abstract: Disorders of Consciousness (DoC) arise from insults to neural networks responsible for awareness and arousal. DoC subtypes are frequently misdiagnosed, as mechanisms underlying consciousness remain poorly understood. Neurostimulation has been investigated as a potential therapy for DoC recovery; however, the evidence for its therapeutic efficacy remains heterogeneous, and the relationship between anatomical target, network modulation, and clinical recovery is unclear. This scoping review evaluates clinical trials investigating neurostimulation in DoC patients, observing trends and assessing the therapeutic significance of network-targeted stimulation, whilst proposing targets for future studies. A comprehensive scoping review was conducted in accordance with PRISMA extension for Scoping Reviews evaluating the efficacy of anatomically targeted neurostimulation in adult patients with DoC. Literature searches were conducted on PubMed, SCOPUS, and Web of Science, with the final search performed in March 2026. Studies were included if they reported quantitative measures of consciousness recovery and had a clearly defined stimulation target. Twenty-two studies were included. Thirteen evaluated the frontoparietal network, the with dorsolateral prefrontal cortex being the most frequent anatomical target, suggesting potential research bias toward this region. Transcranial direct current stimulation and repetitive transcranial magnetic stimulation were the most frequently trialed stimulation modalities. Among studies investigating electrophysiological measures or neuroimaging, improvements in functional connectivity were observed post-stimulation, often correlating with individual-level improvements in clinical consciousness. Nevertheless, group-level outcomes were inconsistent. Six studies reported improvement in consciousness-related behavioral outcomes. No single anatomical target was associated with a clinical response; however, heterogeneity amongst study cohorts and protocols confounded the ability to determine the relative efficacy of network targets. Network-targeted neurostimulation is a promising approach for DoC recovery but remains investigational. Current evidence does not support a single optimal anatomical target, with studies often overlooking individual variations in structural cerebral integrity and connectivity within their cohorts. Future trials should consider using individualized structural and functional mapping, stratify participants by baseline connectivity and clinical subtype, and apply standardized outcome definitions. A more personalized approach to neuromodulation will likely better optimize therapeutic outcomes for consciousness recovery.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2026.1882395