Abstract
ABSTRACT
Background
Severe traumatic brain injury (sTBI) often leads to prolonged coma and poor neurological outcomes. Noninvasive neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and median nerve electrical stimulation (MNS) have shown potential in promoting arousal. However, the efficacy of combining these two approaches remains unclear.
Methods
In this randomized controlled trial, 86 patients with sTBI‐induced coma were assigned to rTMS (
n
= 29), MNS (
n
= 29), or combination therapy (
n
= 28) for 4 weeks. Outcomes included awakening efficacy, EEG grading, cerebral blood‐flow parameters (Vm, Vd, Vs, pulsatility index [PI]), GCS, and MoCA. Safety events were recorded.
Results
At week 4, the combination group demonstrated significantly higher overall awakening efficacy (92.86%, 26/28) compared with the rTMS (65.52%, 19/29) and MNS (62.07%, 18/29) groups (
p
p
p
p
p
> 0.05), with rates numerically lowest in the combination group.
Conclusions
In patients with severe traumatic brain injury and persistent coma, rTMS combined with right MNS significantly improves awakening efficacy, neurophysiological indicators (EEG grading), and cerebral hemodynamics compared with either modality alone. GCS improvement was greatest with combination therapy. Exploratory cognitive findings (MoCA in testable subsets) suggest potential additional benefits, though these require confirmation in future trials employing outcome instruments applicable to all randomized patients. Adverse event rates were low across all groups, with no seizures observed; the study was not powered for formal safety comparisons. These findings support the dual‐pathway neuromodulation paradigm as a promising strategy for consciousness recovery in sTBI and warrant confirmation in multicenter, sham‐controlled trials with extended follow‐up.