Network meta-analysis finds non-pharmacological treatments may improve consciousness in pDOC
This network meta-analysis of 32 randomized controlled trials involving 1770 participants evaluated non-pharmacological treatments for patients with prolonged disorders of consciousness (pDOC), including minimally conscious state (MCS) and unresponsive wakefulness syndrome (UWS). The interventions assessed were repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), median nerve stimulation (MNS), hyperbaric oxygen (HBO), and acupuncture. The primary outcome was improvement in Coma Recovery Scale-Revised (CRS-R) scores.
All five interventions were associated with improved CRS-R scores compared to control. The mean difference (MD) for overall improvement ranged from 17.32 (rTMS) to 3.56 (acupuncture), with 95% credible intervals (CrI) of 6.57 to 104.25 for rTMS and 0.61 to 40.45 for acupuncture. In the MCS subgroup, MD ranged from 15.99 (tDCS) to 9.72 (MNS), with 95% CrI of 1.57 to 66.77 for tDCS and 2.07 to 61.04 for MNS. In the UWS subgroup, MD ranged from 18.52 (rTMS) to 4.12 (acupuncture), with 95% CrI of 2.15 to 108.73 for rTMS and 0.25 to 69.30 for acupuncture.
The authors note that the credible intervals are wide, indicating substantial uncertainty around the effect estimates. The network meta-analysis provides probabilistic rankings, but direct comparisons between interventions are limited. Safety data were not reported. The findings suggest that these non-pharmacological treatments may promote consciousness recovery, but the evidence is not definitive. Clinicians should interpret the results cautiously and consider individual patient factors when selecting treatment.
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