Spinal cord stimulation improves brain connectivity and consciousness level in patients with disorders of consciousness

• Short-term and Long-term Effects: The study demonstrated that short-term SCS did not immediately alter the CRS-R scores, while long-term SCS led to significant improvements in the CRS-R scores for all patients, indicating the potential long-term benefits of SCS in DOC patients. • Neural Connectivity Changes: The EEG results revealed significant changes in Genuine Permutation Cross Mutual Information (G_PCMI) in the frontal and central brain regions before and after short-term SCS, as well as significant differences in PCMI of specific brain regions, highlighting the impact of SCS on cortical connectivity. • Correlation with Behavioral Changes: The study found a significant positive correlation between changes in G_PCMI in specific brain regions and CRS-R changes, suggesting a link between neural connectivity changes and behavioral improvements in DOC patients undergoing SCS treatment. • Clinical Implications: The findings suggest that SCS has the potential to improve the awareness level of DOC patients and enhance both short- and long-distance cortical connectivity, thereby contributing to the improvement of consciousness levels. Spinal cord stimulation (SCS) is an advanced neuromodulation technology in disorders of consciousness (DOC) field. However, research on the modulation effects and mechanisms of SCS is limited. We proposed a study design (SCS and sham) to study the short-term effects of 20 minutes’ SCS, in which resting state EEG and Coma Recovery Scale-Revised (CRS-R) were used to measure the changes in neural and behavioral activity caused by SCS. We use the Genuine Permutation Cross Mutual Information(G_PCMI) to analyze EEG data and study changes in cortical connectivity during SCS. Finally, all patients’ CRS-R results were obtained after 6 months’ SCS treatment. Short-term SCS (20 minutes) did not alter the patient's CRS-R score, but long-term SCS (6 months) can improve the CRS-R scores of all patients. EEG results show G_PCMI of the frontal and central brain regions significantly change before and after short-term SCS (p