Research Paper Volume 16, Issue 8 pp 7119—7130

Single session of intermittent theta burst stimulation alters brain activity of patients in vegetative state

Ying Huang1,2, *, , Xiaoyu Xia3, *, , Xiangqiang Meng1,2, , Yang Bai1,2, , Zhen Feng1,2, ,

  • 1 The Affiliated Rehabilitation Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330003, Jiangxi, China
  • 2 Rehabilitation Medicine Clinical Research Center of Jiangxi Province, Nanchang 330003, Jiangxi, China
  • 3 Department of Neurosurgery, The Seventh Medical Center of PLA General Hospital, Beijing 100700, China
* Equal contribution

Received: September 22, 2023       Accepted: March 18, 2024       Published: April 18, 2024
How to Cite

Copyright: © 2024 Huang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: Non-invasive brain stimulation is considered as a promising technology for treating patients with disorders of consciousness (DOC). Various approaches and protocols have been proposed; however, few of them have shown potential effects on patients with vegetative state (VS). This study aimed to explore the neuro-modulation effects of intermittent theta burst stimulation (iTBS) on the brains of patients with VS and to provide a pilot investigation into its possible role in treating such patients.

Methods: We conducted a sham-controlled crossover study, a real and a sham session of iTBS were delivered over the left dorsolateral prefrontal cortex of such patients. A measurement of an electroencephalography (EEG) and a behavioral assessment of the Coma Recovery Scale-Revised (CRS-R) were applied to evaluate the modulation effects of iTBS before and after stimulation.

Results: No meaningful changes of CRS-R were found. The iTBS altered the spectrum, complexity and functional connectivity of the patients. The real stimulation induced a trend of decreasing of delta power at T1 and T2 in the frontal region, significant increasing of permutation entropy at the T2 in the left frontal region. In addition, brain functional connectivity, particularly inter-hemispheric connectivity, was strengthened between the electrodes of the frontal region. The sham stimulation, however, did not induce any significant changes of the brain activity.

Conclusions: One session of iTBS significantly altered the oscillation power, complexity and functional connectivity of brain activity of VS patients. It may be a valuable tool on modulating the brain activities of patients with VS.


DOC: disorders of consciousness; VS: vegetative state; iTBS: intermittent theta burst stimulation; EEG: electroencephalography; CRS-R: Coma Recovery Scale-Revised; GOS-E: Glasgow Outcome Scale Extension; MCS: minimally conscious state; NIBS: non-invasive brain stimulation; tDCS: transcranial direct current stimulation; rTMS: transcranial magnetic stimulation; TBS: theta burst stimulation; cTBS: continuous TBS; RMT: resting motor threshold; DLPFC: left dorsolateral prefrontal cortex; ICA: independent component analysis; PE: permutation entropy; wPLI: weighted phase lag index.