What Happens in the Brain When Coma Patients Improve After Ultrasound?

A simplified summary of the research

2025medRxiv preprint (under review)2025Loading citations…

Neural Correlates of Behavioral Recovery Following Ultrasonic Thalamic Stimulation in Chronic Disorders of Consciousness

Cain, J. A., Spivak, N., Coetzee, J., Crone, J., Johnson, M., Lutkenhoff, E., ..., Monti, M. M.

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Disorders of Consciousness
Clinical Trial
Focused Ultrasound

doi:10.1101/2023.07.13.23292523

In plain English

What's the Point?

Background

People with chronic disorders of consciousness (long-term coma-like states) have very few treatment options. Earlier work suggested MR-guided thalamic ultrasound could help some patients recover behavior.

Methods

We report the full-cohort trial of thalamic ultrasound in chronic post-coma patients. Behavior was tracked with the CRS-R across repeated sonication sessions, alongside fMRI measures of thalamic and cortical activity and connectivity.

Findings

A subset of patients showed linear behavioral improvements across repeated sonication cycles. Acute changes in thalamic and striatal BOLD activity and in thalamo-cortical connectivity predicted who would go on to recover.

Impact

For the first time, we can link a brain-based signature of an ultrasound treatment to behavioral recovery in disorders of consciousness—crucial groundwork for future sham-controlled and personalized trials.

Abstract

From the manuscript

This full-cohort trial extends earlier proof-of-concept work by combining behavioral (CRS-R) and neuroimaging (fMRI) measures across repeated cycles of MR-guided thalamic focused ultrasound in chronic disorders of consciousness. A subset of patients exhibited linear improvements in CRS-R scores across sonication cycles, and acute changes in thalamic and striatal BOLD activity and thalamo-cortical connectivity were linked to subsequent behavioral recovery. Please see the full preprint for detailed methods and results.

Visual summary — neural correlates of recovery — Visual summaryClick to enlarge
Author-supplied infographic summarizing the trial, neural changes, and recovery.

Figure from the neural correlates of recovery paper — Figure 1 · Network changesClick to enlarge
Brain network changes associated with recovery following repeated thalamic sonication (page rendering from the preprint).

Figure showing CRS-R behavioral time course — Figure 2 · Behavioral trajectoryClick to enlarge
Time course of CRS-R behavioral scores across repeated ultrasound sessions (page rendering from the preprint).

Full citation

Cain, J. A., Spivak, N., Coetzee, J., Crone, J., Johnson, M., Lutkenhoff, E., ... & Monti, M. M. (2025). Neural Correlates of Behavioral Recovery Following Ultrasonic Thalamic Stimulation in Chronic Disorders of Consciousness. medRxiv.