Early High‐Frequency Network Reorganization After Spinal Cord Stimulation Is Linked to Long‐Term Recovery in Disorders of Consciousness

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AIMS: Spinal cord stimulation (SCS) is a promising treatment for disorders of consciousness (DoC), but early neurophysiological markers of durable recovery remain unclear. We aimed to determine whether source-space EEG network energy and communication features capture early brain-network reorganization linked to 6-month recovery in chronic DoC. METHODS: Thirty-one chronic DoC patients undergoing cervical SCS completed resting-state EEG before stimulation and at 1 week and 1 month after stimulation onset. Source-space EEG was analyzed across delta, theta, alpha, and beta bands. NetPower quantified network energy within five canonical networks, and ModularAUC quantified threshold-robust within- and between-network communication. EEG features were related to 6-month CRS-R outcomes. RESULTS: Recovery was associated with sustained alpha/beta NetPower enhancement across default mode, frontoparietal, cingulo-opercular, somatomotor, and occipital networks, peaking at 1 month. Beta-band ModularAUC showed the clearest communication-architecture consolidation, with broader within- and cross-network synergy in recovered patients. Low-frequency changes were weaker and less consistent. High-frequency NetPower features, especially FPN alpha at 1 month and CON beta at 1 week, showed the strongest associations with long-term improvement. CONCLUSIONS: SCS-related recovery in DoC is characterized by high-frequency network-energy enhancement and beta-band communication consolidation. Here, high-frequency network reorganization mainly refers to alpha- and beta-band source-space EEG changes. Source-space EEG may provide early potential neurophysiological markers for monitoring recovery.

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