A shared central thalamus mechanism underlying diverse recoveries in disorders of consciousness

Disorders of consciousness (DoC) encompass a range of states characterized by prolonged altered awareness due to heterogeneous brain damage and are associated with highly diverse prognoses. However, the neural mechanisms underlying such diverse recoveries in DoC remain unclear. To address this issue, we analyzed direct recordings from the central thalamus (CeTh), a key hub in arousal regulation, in a series of 23 DoC patients receiving deep brain stimulation treatment (CeTh-DBS). We identified a core set of electrophysiological features of the CeTh, particularly those of the theta rhythm. These features could account for individual recovery outcomes across highly varied etiologies (trauma, brainstem hemorrhage, and anoxia), and across clinical baselines and patient ages. CeTh activities also identified two subgroups of patients with recovery potential, including those with poor initial clinical manifestations but who eventually exhibited functional recovery. A biophysical model further revealed the neurodynamics of the theta rhythm in the CeTh across different brain states correlating with varying consciousness levels. These findings uncover a shared CeTh mechanism underlying diverse recoveries in DoC.