What question did this study set out to answer?

To synthesize high-level evidence on the efficacy and safety of interventions for traumatic brain injury-related disorders of consciousness.

March 7, 2026Open Access

Efficacy and safety of neuromodulation and multimodal therapies for traumatic brain injury-induced disorders of consciousness: an updated umbrella review

Key Points

To synthesize high-level evidence on the efficacy and safety of interventions for traumatic brain injury-related disorders of consciousness.
Systematic screening of peer-reviewed systematic reviews and meta-analyses across multiple databases.
Appraisal of methodological quality using AMSTAR-2.
Utilization of random- or fixed-effects models based on heterogeneity of studies.
Seven high-quality evidence syntheses from 121 trials demonstrating consistent benefits from neuromodulation.
Repetitive transcranial magnetic stimulation showed significant improvements in CRS-R and GCS scores.
Acupuncture and multisensory stimulation also demonstrated robust efficacy in improving GCS and GOS scores.

Abstract

Background Post-traumatic disorders of consciousness (DoC) remain a major barrier to recovery after traumatic brain injury (TBI), yet therapeutic guidance is fragmented across modalities. Objective To synthesize the highest-level evidence on efficacy and safety of interventions for TBI-related DoC and derive practice-oriented recommendations. Methods Following PRISMA and a prospectively registered protocol (INPLASY202480015), we systematically screened PubMed, Embase, Web of Science, and CNKI through June 2024 for peer-reviewed systematic reviews and meta-analyses focused on TBI-induced DoC. Methodological quality was appraised using AMSTAR-2. Primary outcomes were CRS-R, GCS, GOS, and overall efficacy rate; random- or fixed-effects models were applied per heterogeneity. Results Seven high-quality evidence syntheses encompassing 121 trials and eight interventions were included. Neuromodulation showed consistent benefits: repetitive transcranial magnetic stimulation (rTMS) improved CRS-R (MD 3.00, 95% CI 2.47–3.52) and GCS (MD 2.92, 1.65–4.19); transcranial direct current stimulation (tDCS) improved CRS-R (MD 2.08, 0.63–3.25). Peripheral and sensory approaches were robust: acupuncture improved GCS (MD 2.03, 1.54–2.52), GOS (RR 1.22, 1.16–1.29), and Efficacy Rate (RR 1.48, 1.40–1.56); multisensory stimulation improved GCS (MD 2.28, 2.02–2.54) and GOS (MD 1.11, 0.77–1.45). Right median nerve stimulation (RMNS) and family-centered sensory-affective stimulation also yielded significant gains, while single-study Trigeminal nerve stimulation (TNS) effects were mixed. Conclusions tDCS, rTMS, median nerve stimulation, multisensory stimulation, and acupuncture emerge as leading strategies for TBI-related DoC. We highlight priorities for the field: adequately powered multicenter RCTs with standardized protocols, mechanistic studies to refine dosing and targets, and predictive tools for personalized therapy selection. This umbrella synthesis provides a pragmatic evidence map to accelerate recovery and improve long-term outcomes in this vulnerable population.

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Cite This Study

Yang et al. (Wed,) studied this question.

synapsesocial.com/papers/69abc0925af8044f7a4e94b5 https://doi.org/https://doi.org/10.3389/fneur.2026.1742096

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