Noninvasive neuromodulation for disorders of consciousness: an updated systematic review and meta-analysis
Abstract
Despite advances in noninvasive neuromodulation for disorders of consciousness (DoC), the available evidence is inconclusive. We sought to elucidate the efficacy and safety of these interventions for DoC. We systematically searched Embase, EBSCO, CINAHL, Medline, PsycINFO, the Cochrane Library, and Web of Science from inception until 15 Mar, 2025, supplemented by manual searches from other sources. Randomised controlled trials (RCTs) comparing any noninvasive neuromodulation (e.g., transcranial direct current stimulation [tDCS], repetitive transcranial magnetic stimulation [rTMS], median nerve stimulation [MNS], trigeminal nerve stimulation [TNS], or transauricular vagus nerve stimulation [tVNS]) with sham control for DoC were selected. Relevant data were extracted. Primary efficacy outcome (change in levels of consciousness post intervention) and safety outcome (adverse events and dropout) were assessed. Effect sizes were pooled for standard pairwise meta-analyses using random-effects model and reported as Hedges’ g or risk ratio (RR) with 95% confidence interval (CI). Studies with less than five stimulation sessions were excluded. Methodological quality was assessed by the PEDro scale, risk of bias was evaluated using the RoB 2 tool. Heterogeneity was measured using τ2 and I2 statistic. The quality of evidence was performed using the Grade approach. We included 24 studies and six studies (147 participants) provided data for meta-analysis. The methodological quality was…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 147 participants or records.
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