Modulation of cortical functional connectivity and spectrum with transcranial focused ultrasound in chronic disorders of consciousness: a case report
Shu Cheng, Xuan Xu, Lei Lei, Fanyuan Meng, Xiaojing Long, Qihui Liang, Kaixuan Luo, Xiangjun Feng, Moxian Chen, Lijuan Ao
Frontiers in Psychiatry 2026 · 10.3389/fpsyt.2026.1748927
Abstract
Objectives Chronic disorders of consciousness (DOC) represent a profound clinical challenge with few effective therapeutic options. Transcranial focused ultrasound (tFUS) is an emerging non-invasive neuromodulation technique capable of targeting deep brain structures implicated in consciousness, such as the thalamus. In this work, we present a longitudinal, multi-modal investigation into the clinical and neural outcomes following thalamic tFUS in a patient with chronic DOC. Methods A patient in a chronic minimally conscious state underwent a course of tFUS treatment targeting the right central thalamus. The intervention was applied for 20 minutes, three times per week, over a period of four weeks (12 sessions in total). We conducted comprehensive longitudinal assessments using clinical scales (Coma Recovery Scale-Revised and Glasgow Coma Scale). Besides, resting-state functional near-infrared spectroscopy (fNIRS) to measure cortical functional connectivity, and electroencephalogram (EEG) to analyze neurophysiological dynamics. Results The patient demonstrated a progressive and clinically significant behavioral recovery, ultimately emerging from the minimally conscious state. This recovery was accompanied by observable neural reorganization. fNIRS revealed a systematic enhancement of functional connectivity, especially within the prefrontal cortex and between prefrontal-sensorimotor networks. Concurrently, EEG analysis showed a marked, progressive suppression of pathological slow-wave (Delta and Theta) power in frontal regions. The intervention was well-tolerated with no adverse events or structural brain changes observed. Conclusions This case provides cohesive, multi-modal evidence suggesting that targeted thalamic tFUS may be associated with a restorative process, concurrent with the normalization of dysfunctional cortical rhythms and the reintegration of large-scale brain networks that parallel the recovery of consciousness. Our findings offer preliminary insights supporting the continued investigation of tFUS as a potential therapeutic strategy for patients with severe brain injury.
Abstract via europepmc.
Exposures
Exposure 1: tFUS to right central thalamus
Target: thalamus — “right central thalamus”
Device: other named manufacturer · GreenValley BrainTech Medical Technology Co. Ltd · single-element ultrasonic probe, rectangular aperture 80mm × 45mm, focusing curvature 85mm ✓
| Waveform | pulsed | |
|---|---|---|
| Fundamental frequency (kHz) | 650 | ✓✓✓ |
| Pulse duration (ms) | 300 | ✓✓✓⚑ |
| Pulse repetition frequency (Hz) | 200 | ✓✓✓ |
| Duty cycle (%) | 6pulse duration × PRF gives 6000%, which disagrees with the stated value | ✓✓✓ |
| Sonication duration (s) | 1 | ✓✓✓⚑ |
| Free-field pressure (kPa) | 1,200 | ✓✓✓ |
|---|---|---|
| Free-field Isppa (W/cm²) | 12 | ✓✓✓ |
| Free-field Ispta (W/cm²) | 0.72 | ✓✓✓ |
| In-situ estimate | not reported | |
| In-situ pressure (kPa) | not reported | |
| In-situ Isppa (W/cm²) | not reported | |
| In-situ Ispta (W/cm²) | not reported |
Pulse duration 300 ms, pulse repetition interval 5 ms, PRF 200 Hz, duty cycle 6%; pulse trains delivered every 6 seconds with a 5-second inter-stimulation interval; 20 minutes per session, three times per week for four weeks (12 sessions). The text giving the pulse train duration is truncated in the source.
Consistency checks: pd exceeds period; intensity pressure inconsistent free field.
Flags from extraction
exposures[0].timing.pulse_duration_ms— Text states pulse duration 300 ms with a 5 ms pulse repetition interval and 6% duty cycle; these are mutually inconsistent (300 ms exceeds the 5 ms interval). Recorded as written; possibly 300 microseconds.exposures[0].timing.sonication_duration_s— Pulse train duration sentence is truncated in the source text ('was set to 1'); not recorded.exposures[0].unspecified_domain.pressure_kpa— Pressure described as incident peak-to-peak amplitude at the focal point; domain not stated explicitly (free-field estimate per figure text), so placed in unspecified_domain. Peak-to-peak 1.2 MPa converted to 1200 kPa.exposures[0].device.family— Maker named only as GreenValley BrainTech; recorded as other_manufacturer.n_subjects— Single-case report; quote does not contain a numeral.exposures[0].target.terms— Target is the 'central thalamus'; mapped to thalamus.