Comparative Efficacy of Noninvasive Neuromodulation in Patients with Disorders of Consciousness: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

First published online October 25, 2026. Across randomized studies, several noninvasive stimulation approaches showed promising consciousness-scale signals. Because populations, causes and protocols differed, the rankings are research leads rather than proof that one approach is best for every patient.

Huang L, Wang L, Ye S, Sun X, He X, Zhang Z, He C, wei Q.
Neurorehabilitation and Neural Repair · Publication date: 2026-10-25
Added to site: 2026-10-26
DOI: 10.1177/15459683261493913

First published online October 25, 2026. Added to Neurofeedback.com October 26, 2026.

Modalities

rTMS, tDCS, Peripheral nerve stimulation

Clinical focus

Disorders of consciousness, Consciousness recovery, Neurorehabilitation

Population

People with disorders of consciousness from traumatic and nontraumatic causes

Sample

41 studies included, with 19 entering quantitative analysis; the checked abstract does not report the total participant denominator

Intervention / method

Database and trial-registry search with PEDro bias assessment and network comparison of several noninvasive neuromodulation approaches

Comparator

Network of sham, usual-care and active neuromodulation comparisons across included randomized trials

Clinician summary

High-frequency rTMS over primary motor cortex had the largest reported Coma Recovery Scale-Revised estimate, MD 7.1, 95% CI 2.6 to 11. Combined right median nerve stimulation and high-frequency prefrontal rTMS followed at MD 5.0, 95% CI 2.6 to 7.5, and median nerve stimulation alone at MD 3.0, 95% CI 1.1 to 4.9. The authors reported generally low bias and model heterogeneity below 5%.

How to interpret the findings

Only 19 of 41 studies entered the quantitative network, and the checked abstract does not report the total participant denominator, direct-versus-indirect consistency checks, treatment-session detail, adverse events or long-term outcomes. Network rankings depend on cross-trial comparability. Heterogeneous etiologies and durations limit generalization, and the authors explicitly characterize the findings as hypothesis-generating.

Equipment and disclosures

The review spans rTMS, tDCS and peripheral-stimulation protocols. It does not establish a superior commercial device and makes no BrainMaster attribution.

Registered as PROSPERO CRD420251018090. Crossref lists National Natural Science Foundation of China award 82302867, China Postdoctoral Science Foundation award 2023M732443 and National Key Research and Development Program awards 2020YFC2008500 and 2020YFC2008502. Competing-interest detail was not available in the checked abstract. No indexed correction, retraction or expression-of-concern relation appeared in the retained records; this is a bounded check. AI-assisted source review.

Related evidence

Compare findings from the same clinical area, including mixed results.

• Clinically unresponsive patients with acute brain injury activate a brain-computer interface · Positive with limitations
• Detecting EEG index of arousal in sleeping patients with unresponsive wakefulness syndrome · Positive with limitations
• HD-tACS at 40 Hz Improves Consciousness and Brain Connectivity in Prolonged Disorders of Consciousness: A Randomized Sham-Controlled Clinical Trial. · Positive with limitations
• Repetitive Transcranial Magnetic Stimulation Combined With Median Nerve Electrical Stimulation for Severe Traumatic Brain Injury. · Positive with limitations