{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:58:57Z","timestamp":1760144337650,"version":"build-2065373602"},"reference-count":64,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T00:00:00Z","timestamp":1712793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Brain imaging studies have recently provided some evidence in favor of covert cognitive processes that are ongoing in patients with disorders of consciousness (DoC) (e.g., a minimally conscious state and vegetative state\/unresponsive wakefulness syndrome) when engaged in passive sensory stimulation or active tasks such as motor imagery. In this exploratory study, we used transcranial magnetic stimulation (TMS) of the motor cortex to assess modulations of corticospinal excitability induced by action observation in eleven patients with DoC. Action observation is known to facilitate corticospinal excitability in healthy subjects, unveiling how the observer\u2019s motor system maps others\u2019 actions onto her\/his motor repertoire. Additional stimuli were non-biological motion and acoustic startle stimuli, considering that sudden and loud acoustic stimulation is known to lower corticospinal excitability in healthy subjects. The results indicate that some form of motor resonance is spared in a subset of patients with DoC, with some significant difference between biological and non-biological motion stimuli. However, there was no covariation between corticospinal excitability and the type of DoC diagnosis (i.e., whether diagnosed with VS\/UWS or MCS). Similarly, no covariation was detected with clinical changes between admission and discharge in clinical outcome measures. Both motor resonance and the difference between the resonance with biological\/non-biological motion discrimination correlated with the amplitude of the N20 somatosensory evoked potentials, following the stimulation of the median nerve at the wrist (i.e., the temporal marker signaling the activation of the contralateral primary somatosensory cortex). Moreover, the startle-evoking stimulus produced an anomalous increase in corticospinal excitability, suggesting a functional dissociation between cortical and subcortical circuits in patients with DoC. Further work is needed to better comprehend the conditions in which corticospinal facilitation occurs and whether and how they may relate to individual clinical parameters.<\/jats:p>","DOI":"10.3390\/brainsci14040371","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T07:09:28Z","timestamp":1712819368000},"page":"371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Modulation of Corticospinal Excitability during Action Observation in Patients with Disorders of Consciousness"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8451-9277","authenticated-orcid":false,"given":"Mauro","family":"Mancuso","sequence":"first","affiliation":[{"name":"Physical and Rehabilitative Medicine Unit, NHS-USL Tuscany South-Est, 58100 Grosseto, Italy"},{"name":"Tuscany Rehabilitation Clinic, 52025 Montevarchi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Mencarelli","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5304-3974","authenticated-orcid":false,"given":"Laura","family":"Abbruzzese","sequence":"additional","affiliation":[{"name":"Tuscany Rehabilitation Clinic, 52025 Montevarchi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetta","family":"Basagni","sequence":"additional","affiliation":[{"name":"Tuscany Rehabilitation Clinic, 52025 Montevarchi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6351-2455","authenticated-orcid":false,"given":"Pierluigi","family":"Zoccolotti","sequence":"additional","affiliation":[{"name":"Tuscany Rehabilitation Clinic, 52025 Montevarchi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5312-9367","authenticated-orcid":false,"given":"Cristiano","family":"Scarselli","sequence":"additional","affiliation":[{"name":"Tuscany Rehabilitation Clinic, 52025 Montevarchi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Capitani","sequence":"additional","affiliation":[{"name":"Tuscany Rehabilitation Clinic, 52025 Montevarchi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Neri","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emiliano","family":"Santarnecchi","sequence":"additional","affiliation":[{"name":"Precision Neuroscience & Neuromodulation Program, Gordon Center for Medical Imaging, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6697-9459","authenticated-orcid":false,"given":"Simone","family":"Rossi","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Siena Brain Investigation and Neuromodulation (Si-BIN) Lab, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1038\/nrneurol.2013.279","article-title":"Disorders of consciousness after acquired brain injury: The state of the science","volume":"10","author":"Giacino","year":"2014","journal-title":"Nat. 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