{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:08:34Z","timestamp":1792112914292,"version":"4.4.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005090","name":"Beijing Nova Program","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005090","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Spasticity frequently complicates disorders of consciousness (DoC) after severe brain injury, yet effective treatments addressing both conditions remain limited. Spinal cord stimulation (SCS) has shown promise in treating each condition independently, but its application in patients with concurrent DoC and spasticity has rarely been systematically investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We report a 30-year-old man with prolonged DoC and severe limb spasticity following traumatic brain injury who underwent dual-level percutaneous SCS lead implantation. Frequency screening was performed to identify optimal stimulation parameters, followed by 21 days of continuous stimulation. Assessments included the Coma Recovery Scale\u2013Revised (CRS-R), Modified Ashworth Scale (MAS), Hip Adductor Tone Scale (HATS), surface electromyography (sEMG), electroencephalography (EEG), and transcranial magnetic stimulation (TMS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Frequency screening identified 80 Hz as the optimal parameter for spasticity reduction. After 21 days of stimulation, the CRS-R score increased from 5 to 10, MAS improved from 3\u20134 to 1\u20131+ , and HATS decreased from 3 to 1. sEMG showed reduced muscle activity and spectral shifts consistent with decreased spasticity. EEG demonstrated enhanced frontotemporal functional connectivity and increased spectral power. TMS motor evoked potential latency was significantly shortened. Clinical improvements were sustained at the 6-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case suggests that 80 Hz SCS may be associated with concurrent improvement in consciousness and spasticity in patients with DoC following severe brain injury, accompanied by electrophysiological correlates of altered neural connectivity and corticospinal function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnins.2026.1866882","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T08:09:28Z","timestamp":1785226168000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Spinal cord stimulation for concurrent improvement of consciousness and spasticity following severe traumatic brain injury: a case study"],"prefix":"10.3389","volume":"20","author":[{"given":"Yitong","family":"Jia","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianming","family":"Wang","sequence":"additional","affiliation":[{"name":"National Key Laboratory of Advanced Micro and Nano Manufacture Technology, School of Integrated Circuits, Peking University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Second Affiliated Hospital of Soochow University","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sipeng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiheng","family":"He","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianqing","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoke","family":"Chai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyi","family":"Zhai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"China National Clinical Research Center for Neurological Diseases","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1080\/09638280500535165","article-title":"Relation between spasticity, weakness and contracture of the elbow flexors and upper limb activity after stroke: an observational study.","volume":"28","author":"Ada","year":"2006","journal-title":"Disabil. Rehabil"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1011465","DOI":"10.1371\/journal.pcbi.1011465","article-title":"Integrated information theory (IIT) 4.0: formulating the properties of phenomenal existence in physical terms.","volume":"19","author":"Albantakis","year":"2023","journal-title":"PLoS Comput. Biol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"110531","DOI":"10.1016\/j.resuscitation.2025.110531","article-title":"Temporal dynamics of neural synchrony and complexity of auditory EEG responses in post-hypoxic ischemic coma.","volume":"208","author":"Alnes","year":"2025","journal-title":"Resuscitation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1177\/13524585251357143","article-title":"Percutaneous epidural spinal cord stimulation immediately reduces clonus in an individual with multiple sclerosis.","volume":"32","author":"Asp","year":"2025","journal-title":"Mult. Scler"},{"key":"B5","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.wneu.2021.07.077","article-title":"Spinal cord stimulation via percutaneous and open implantation: systematic review and meta-analysis examining complication rates.","volume":"154","author":"Blackburn","year":"2021","journal-title":"World Neurosurg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1038\/s41582-020-00428-x","article-title":"Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies.","volume":"17","author":"Edlow","year":"2021","journal-title":"Nat. Rev. Neurol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1002\/mus.24776","article-title":"Randomized, placebo-controlled trial of incobotulinumtoxina for upper-limb post-stroke spasticity.","volume":"53","author":"Elovic","year":"2016","journal-title":"Muscle Nerve"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1728","DOI":"10.1038\/s41593-018-0262-6","article-title":"Electrical spinal cord stimulation must preserve proprioception to enable locomotion in humans with spinal cord injury.","volume":"21","author":"Formento","year":"2018","journal-title":"Nat. Neurosci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1152\/jn.00695.2003","article-title":"Effect of rhythmic arm movement on reflexes in the legs: modulation of soleus H-reflexes and somatosensory conditioning.","volume":"91","author":"Frigon","year":"2004","journal-title":"J. Neurophysiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1038\/s41467-020-20703-1","article-title":"Recruitment of upper-limb motoneurons with epidural electrical stimulation of the cervical spinal cord.","volume":"12","author":"Greiner","year":"2021","journal-title":"Nat. Commun"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1403156","DOI":"10.3389\/fnagi.2024.1403156","article-title":"Anatomical-related factors and outcome of percutaneous short-term spinal cord stimulation electrode shift in patients with disorders of consciousness: a retrospective study.","volume":"16","author":"He","year":"2024","journal-title":"Front. Aging Neurosci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.wneu.2023.12.158","article-title":"Epidural spinal cord stimulation for spasticity: a systematic review of the literature.","volume":"183","author":"Jung","year":"2024","journal-title":"World Neurosurg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"100079","DOI":"10.70389\/PJS.100079","article-title":"Revised Surgical CAse REport (SCARE) guideline: an update for the age of Artificial Intelligence.","volume":"10","author":"Kerwan","year":"2025","journal-title":"Premier J. Sci."},{"key":"B14","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1136\/practneurol-2011-000155","article-title":"Spasticity: pathophysiology, evaluation and management.","volume":"12","author":"Kheder","year":"2012","journal-title":"Pract. Neurol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1002\/(SICI)1097-0193(1999)8:4<194::AID-HBM4>3.0.CO;2-C","article-title":"Measuring phase synchrony in brain signals.","volume":"8","author":"Lachaux","year":"1999","journal-title":"Hum. Brain Mapp."},{"key":"B16","doi-asserted-by":"publisher","first-page":"162","DOI":"10.3390\/brainsci7120162","article-title":"Spasticity management in disorders of consciousness.","volume":"7","author":"Martens","year":"2017","journal-title":"Brain Sci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"4189","DOI":"10.1140\/epjs\/s11734-025-01514-1","article-title":"Changes in functional connectivity of brain regions associated with movement and awareness under the influence of cervical epidural spinal cord stimulation in chronic disorders of consciousness: a pilot study.","volume":"234","author":"Mayorova","year":"2025","journal-title":"Eur. Phys. J. Spec. Top."},{"key":"B18","doi-asserted-by":"publisher","first-page":"2266","DOI":"10.3390\/biomedicines11082266","article-title":"Immediate effects of anti-spastic epidural cervical spinal cord stimulation on functional connectivity of the central motor system in patients with stroke- and traumatic brain injury-induced spasticity: a pilot resting-state functional magnetic resonance imaging study.","volume":"11","author":"Mayorova","year":"2023","journal-title":"Biomedicines"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1533212","DOI":"10.3389\/fnhum.2025.1533212","article-title":"Functional connectome integration observed after antispastic epidural cervical spinal cord stimulation in a patient with TBI-induced disorder of consciousness: a case report.","volume":"19","author":"Mayorova","year":"2025","journal-title":"Front. Hum. Neurosci"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.1007\/s00234-012-1087-8","article-title":"Spinal cord stimulation modulates cerebral function: an fMRI study.","volume":"54","author":"Moens","year":"2012","journal-title":"Neuroradiology"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1861","DOI":"10.1016\/j.apmr.2013.05.027","article-title":"Descriptive characteristics and rehabilitation outcomes in active duty military personnel and veterans with disorders of consciousness with combat- and noncombat-related brain injury.","volume":"94","author":"Nakase-Richardson","year":"2013","journal-title":"Arch. Phys. Med. Rehabil"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e77462","DOI":"10.7554\/eLife.77462","article-title":"Disruption in structural-functional network repertoire and time-resolved subcortical fronto-temporoparietal connectivity in disorders of consciousness.","volume":"11","author":"Panda","year":"2022","journal-title":"Elife"},{"key":"B23","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1038\/s41591-022-02202-6","article-title":"Epidural stimulation of the cervical spinal cord for post-stroke upper-limb paresis.","volume":"29","author":"Powell","year":"2023","journal-title":"Nat Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"0314","DOI":"10.34133\/cbsystems.0314","article-title":"Epidural electrical stimulation for functional recovery in incomplete spinal cord injury.","volume":"6","author":"Ren","year":"2025","journal-title":"Cyborg. Bionic. Syst"},{"key":"B25","doi-asserted-by":"publisher","first-page":"ead9607","DOI":"10.1126\/scitranslmed.adp9607","article-title":"High-frequency epidural electrical stimulation reduces spasticity and facilitates walking recovery in patients with spinal cord injury.","volume":"17","author":"Romeni","year":"2025","journal-title":"Sci. Transl. Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1016\/j.clinph.2015.02.001","article-title":"Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee.","volume":"126","author":"Rossini","year":"2015","journal-title":"Clin. Neurophysiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"7872","DOI":"10.1523\/JNEUROSCI.1106-19.2019","article-title":"Imbalanced corticospinal and reticulospinal contributions to spasticity in humans with spinal cord injury.","volume":"39","author":"Sangari","year":"2019","journal-title":"J. Neurosci"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.tins.2009.11.002","article-title":"Recovery of consciousness after brain injury: a mesocircuit hypothesis.","volume":"33","author":"Schiff","year":"2010","journal-title":"Trends Neurosci"},{"key":"B29","doi-asserted-by":"publisher","first-page":"64","DOI":"10.3171\/2011.2.SPINE1068","article-title":"Heuristic map of myotomal innervation in humans using direct intraoperative nerve root stimulation.","volume":"15","author":"Schirmer","year":"2011","journal-title":"J. Neurosurg. Spine"},{"key":"B30","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1111\/j.1468-1331.2010.03129.x","article-title":"Botulinum toxin assessment, intervention and after-care for upper limb hypertonicity in adults: international consensus statement.","volume":"17","author":"Sheean","year":"2010","journal-title":"Eur. J. Neurol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e70180","DOI":"10.1111\/cns.70180","article-title":"Spinal cord stimulation for prolonged disorders of consciousness: a study on scalp electroencephalography.","volume":"30","author":"Sun","year":"2024","journal-title":"CNS Neurosci. Ther"},{"key":"B32","first-page":"389","article-title":"Spasticity in disorders of consciousness: a behavioral study.","volume":"51","author":"Thibaut","year":"2015","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e65753","DOI":"10.7759\/cureus.65753","article-title":"Clinical outcome after epidural spinal cord stimulation in patients with severe traumatic brain injury.","volume":"16","author":"Vorobyev","year":"2024","journal-title":"Cureus"},{"key":"B34","doi-asserted-by":"publisher","first-page":"681","DOI":"10.26355\/eurrev_202301_31070","article-title":"The use of epidural spinal cord stimulation in patients with chronic disorders of consciousness - neuroimaging and clinical results.","volume":"27","author":"Vorobyev","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"B35","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12868-024-00877-w","article-title":"Changes of brain functional network in Alzheimer\u2019s disease and frontotemporal dementia: a graph-theoretic analysis.","volume":"25","author":"Wu","year":"2024","journal-title":"BMC Neurosci"},{"key":"B36","doi-asserted-by":"publisher","first-page":"3059","DOI":"10.1007\/s00221-016-4715-4","article-title":"Neuromechanical interactions between the limbs during human locomotion: an evolutionary perspective with translation to rehabilitation.","volume":"234","author":"Zehr","year":"2016","journal-title":"Exp. Brain Res"},{"key":"B37","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1002\/pmrj.12458","article-title":"Spasticity management in persons with disorders of consciousness.","volume":"13","author":"Zhang","year":"2021","journal-title":"PM R"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e14388","DOI":"10.1111\/cns.14388","article-title":"Combined behavioral and EEG evidence for the 70 Hz frequency selection of short-term spinal cord stimulation in disorders of consciousness.","volume":"30","author":"Zhuang","year":"2024","journal-title":"CNS Neurosci. Ther"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1026221","DOI":"10.3389\/fneur.2022.1026221","article-title":"Effects of short-term spinal cord stimulation on patients with prolonged disorder of consciousness: a pilot study.","volume":"13","author":"Zhuang","year":"2022","journal-title":"Front. Neurol"}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1866882\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T08:09:30Z","timestamp":1785226170000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2026.1866882\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":39,"alternative-id":["10.3389\/fnins.2026.1866882"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2026.1866882","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"article-number":"1866882"}}