History of Disorders of consciousness

Trials of acupuncture for disorders of consciousness enrol people who have survived a severe brain injury or stroke but have not woken fully, and measure whether they become more responsive. The states run from coma, in which a person neither opens their eyes nor responds; through the vegetative state, now also called unresponsive wakefulness syndrome, in which the eyes open but no sign of awareness appears; to the minimally conscious state, in which signs of awareness come and go. A disorder that persists for weeks after the injury is called prolonged. Most trials score responsiveness on the Glasgow Coma Scale (GCS), a bedside score of eye opening, speech and movement, or on the Coma Recovery Scale-Revised (CRS-R), a longer bedside assessment; on both a higher score means a more responsive patient. Several trials also report an awakening or "resuscitation" rate, the share of patients judged to have regained consciousness. Traumatic brain injury (/wiki/evidence/traumatic-brain-injury) reports the acupuncture research on that injury as a whole, and Stroke recovery (/wiki/evidence/stroke-recovery) the research on movement, speech and swallowing after stroke. The reviews below compare acupuncture in two ways that answer different questions: against sham acupuncture, a control procedure made to resemble the real one ( Sham acupuncture (/wiki/research/sham-acupuncture) describes the kinds in use); and added to usual care against usual care alone, in which the staff giving treatment know which group a patient is in. Almost every pooled trial is of the second kind. Is there a Cochrane review? Cochrane has no review of acupuncture for coma or disorders of consciousness. Its 2013 review of acupuncture for traumatic brain injury (https://doi.org/10.1002/14651858.CD007700.pub3) , by Wong and colleagues, found four eligible trials with 294 participants across all outcomes, one of them in comatose patients, and judged that their low methodological quality allowed no conclusion on efficacy or safety. Traumatic brain injury (/wiki/evidence/traumatic-brain-injury) sets out what that review found. Reviews after stroke A 2024 review (https://doi.org/10.1016/j.ctim.2024.103046) by Wu and colleagues in Complementary Therapies in Medicine searched English and Chinese databases to November 2023 and included 34 randomised trials with 2,757 patients in coma after stroke. GCS was 1.78 points higher with acupuncture than in the control groups, and the National Institutes of Health Stroke Scale, on which a lower score means less neurological deficit, was 2.84 points lower. Acupuncture added to routine treatment raised the awakening rate against routine treatment alone (risk ratio 1.65). The authors list missing blinding, unsuitable assessment of the disorder and varied interventions among the trials' flaws, and call for trials with better randomisation, blinding and longer follow-up. An earlier 2022 review (https://doi.org/10.3389/fneur.2022.930546) by Huang and colleagues in Frontiers in Neurology searched to November 2021 and included 17 trials with 1,208 patients with disorders of consciousness after stroke. It rated most trials at high risk of bias or with some concerns, and graded the certainty of every outcome very low. Results by comparison: - Acupuncture with or without other care, against no acupuncture (16 trials): GCS 1.45 points higher. - Acupuncture alone, against medication alone (3 trials, 214 patients): no difference in GCS. - Resuscitation rate (4 trials): higher with acupuncture, risk ratio 1.68. Two trials reported adverse events; one patient given acupuncture had a bruise under the skin. The point most often used across the trials was GV26 (/points/gv26) (Shuigou, also called Renzhong), in 16 of them, followed by PC06 (/points/pc06) (Neiguan) in 12, GV20 (/points/gv20) (Baihui) in 10 and SP06 (/points/sp06) (Sanyinjiao) in 9. Reviews after traumatic brain injury and across causes A 2019 review (https://doi.org/10.1155/2019/5190515) by Tan and colleagues pooled 49 trials with 3,511 patients with disorders of consciousness after traumatic brain injury and found GCS 2.03 points higher with acupuncture. Every trial compared acupuncture with basic treatment; none used a sham, and patients were not blinded. Only 12 trials fully described how they randomised, and the authors judged the funnel plot asymmetric, a sign that negative trials may be missing. A 2026 umbrella review (https://doi.org/10.3389/fneur.2026.1742096) by Yang and colleagues, which pooled seven reviews of interventions for disorders of consciousness after traumatic brain injury, drew its acupuncture figures from the Tan review alone. A 2026 network meta-analysis (https://doi.org/10.3389/fneur.2026.1754777) by Xu and colleagues, in Frontiers in Neurology, compared five non-drug treatments for prolonged disorders of consciousness of any cause across 32 trials with 1,770 participants, searched to December 2024. A network meta-analysis compares treatments that were never tested against each other by linking them through shared control groups, and this one placed no limit on what the control group received. Its estimate for acupuncture was a CRS-R 3.56 points higher (95% credible interval 0.61 to 40.45), the smallest estimate of the five; for repetitive transcranial magnetic stimulation, magnetic pulses through the skull, the estimate was 17.32. Median nerve stimulation Median nerve stimulation passes a current through pads on the front of the right forearm, over the nerve that runs to the hand, with no needle. The trials below describe it as electrical nerve stimulation rather than acupuncture, and the reviews above count it as a separate treatment; it appears here because it shares their patients, their outcomes and, in one trial, a treatment arm with ear acupuncture. The ACES trial (https://doi.org/10.1007/s00134-023-07072-1) , published in Intensive Care Medicine in 2023, randomised 329 people in coma 7 to 14 days after traumatic brain injury, across 22 centres in China, to right median nerve stimulation for 8 hours a day for 2 weeks plus routine treatment, or routine treatment alone. Six months after injury 72.5% of the stimulated group had regained consciousness against 56.8% of the control group. The authors report that the trial was underpowered after the COVID-19 pandemic cut recruitment, that muscle twitching partly unblinded it, and that the result needs a confirmatory trial. A 2025 review (https://doi.org/10.1007/s12028-024-02141-9) by Yang and colleagues in Neurocritical Care pooled 18 trials with 1,831 patients in coma after traumatic brain injury, searched to July 2023. More patients regained consciousness with stimulation than without, both after treatment (risk ratio 1.36) and at 6 months (1.31), and GCS was 2.38 points higher; pneumonia, seizures and stomach bleeding did not differ between groups. A 2025 review of safety (https://doi.org/10.1371/journal.pone.0324046) by Gu and colleagues, in PLoS One, found no rise in complications with median nerve stimulation in disorders of consciousness, but graded the certainty of that evidence low. Trials against a control procedure A 2026 trial (https://doi.org/10.1055/s-0046-1825520) by Lang and colleagues, published in Arquivos de Neuro-Psiquiatria, randomised 48 patients with prolonged disorders of consciousness to electroacupuncture (/wiki/techniques/electroacupuncture) , in which a current runs between the needles, at BL02 (/points/bl02) (Cuanzhu) and ST02 (/points/st02) (Sibai), or to sham electroacupuncture, for 3 weeks. Assessors did not know the groups. The awakening rate was 70.8% with electroacupuncture and 54.2% with sham, a difference that was not statistically significant, and outcome at 3 months did not differ. A 2026 trial (https://doi.org/10.1007/s12028-026-02543-x) by Li and colleagues in Neurocritical Care randomised 116 patients with disorders of consciousness after acquired brain injury, with GCS of 4 to 8, to median nerve stimulation plus small press needles left in five ear acupuncture (/wiki/techniques/ear-acupuncture) points, or to median nerve stimulation alone, over 11 days. Assessors did not know the groups. CRS-R rose 1.62 points more with the ear needles at 4 weeks and 2.05 points more at 3 months, and 48% against 28% of patients had woken at 4 weeks. No serious treatment-related adverse event occurred. The comparison isolates the ear needling, but without a sham the treating staff knew who received it. The AcuDoc trial (https://doi.org/10.1002/brb3.70637) , whose protocol Lin and colleagues published in Brain and Behavior in 2025, plans to randomise 50 adults with disorders of consciousness after traumatic brain injury to 14 days of electroacupuncture, with GV26 as the main point, or sham electroacupuncture, with change in CRS-R as the primary outcome. The authors describe it as the first randomised sham-controlled trial of electroacupuncture in disorders of consciousness. No results had appeared in Europe PMC by October 2026. What guidelines say The 2018 practice guideline (https://doi.org/10.1212/wnl.0000000000005926) of the American Academy of Neurology, the American Congress of Rehabilitation Medicine and the US National Institute on Disability, Independent Living, and Rehabilitation Research, by Giacino and colleagues, recommends amantadine for adults with traumatic vegetative or minimally conscious states; its recommendations summary does not mention acupuncture or median nerve stimulation. A search of Europe PMC in October 2026 found no later version. The German S3 guideline on neurological rehabilitation in coma and disorders of consciousness, registered with the AWMF, the association of German medical societies, as 080-006 and dated January 2023, is summarised in English (https://doi.org/10.3238/arztebl.m2023.0159) by Bender and colleagues in Deutsches Ärzteblatt International. It found the strongest evidence for amantadine and for transcranial direct current stimulation in the minimally conscious state, and states that for lack of data it could make no recommendation for or against acupuncture or median nerve stimulation. Its current status in the AWMF register is not confirmed here. What the reviews could not settle The pooled trials add acupuncture to usual care and compare it with usual care alone, so they cannot separate an effect of the needling from the extra attention that comes with it; the one completed sham-controlled trial on this page enrolled 48 patients and found no significant difference. The stroke review (https://doi.org/10.3389/fneur.2022.930546) graded certainty very low for every outcome, and the 2019 review (https://doi.org/10.1155/2019/5190515) found signs that negative trials are missing and reported that points, stimulation, duration and frequency varied from trial to trial. The 2024 review (https://doi.org/10.1016/j.ctim.2024.103046) names long-term follow-up among what the trials lack. Whether acupuncture adds anything to median nerve stimulation, magnetic or electrical brain stimulation, or amantadine is untested except in the single ear-needle trial above. AcuiQ's coma page (/symptoms/coma) lists the protocols individual studies prescribed, each with its citation.