# Modulation of cortical functional connectivity and spectrum with transcranial focused ultrasound in chronic disorders of consciousness: a case report

## TL;DR

This case report explores the use of transcranial focused ultrasound to treat a patient with chronic consciousness disorder, showing behavioral and neural improvements.

## Contribution

The study presents the first longitudinal, multi-modal evidence of tFUS-induced neural and behavioral recovery in chronic disorders of consciousness.

## Key findings

- The patient showed progressive behavioral recovery from a minimally conscious state.
- fNIRS revealed enhanced functional connectivity in prefrontal and sensorimotor networks.
- EEG showed reduced pathological slow-wave power in frontal regions.

## Abstract

Chronic disorders of consciousness (DOC) represent a profound clinical challenge with few effective therapeutic options. Transcranial focused ultrasound (tFUS) is an emerging non-invasive neuromodulation technique capable of targeting deep brain structures implicated in consciousness, such as the thalamus. In this work, we present a longitudinal, multi-modal investigation into the clinical and neural outcomes following thalamic tFUS in a patient with chronic DOC.

A patient in a chronic minimally conscious state underwent a course of tFUS treatment targeting the right central thalamus. The intervention was applied for 20 minutes, three times per week, over a period of four weeks (12 sessions in total). We conducted comprehensive longitudinal assessments using clinical scales (Coma Recovery Scale-Revised and Glasgow Coma Scale). Besides, resting-state functional near-infrared spectroscopy (fNIRS) to measure cortical functional connectivity, and electroencephalogram (EEG) to analyze neurophysiological dynamics.

The patient demonstrated a progressive and clinically significant behavioral recovery, ultimately emerging from the minimally conscious state. This recovery was accompanied by observable neural reorganization. fNIRS revealed a systematic enhancement of functional connectivity, especially within the prefrontal cortex and between prefrontal-sensorimotor networks. Concurrently, EEG analysis showed a marked, progressive suppression of pathological slow-wave (Delta and Theta) power in frontal regions. The intervention was well-tolerated with no adverse events or structural brain changes observed.

This case provides cohesive, multi-modal evidence suggesting that targeted thalamic tFUS may be associated with a restorative process, concurrent with the normalization of dysfunctional cortical rhythms and the reintegration of large-scale brain networks that parallel the recovery of consciousness. Our findings offer preliminary insights supporting the continued investigation of tFUS as a potential therapeutic strategy for patients with severe brain injury.