Expert consensus on clinical application of transcranial magnetic stimulation and transcranial ultrasound stimulation in disorders of consciousness

Disorders of consciousness (DoC) are common clinical problems after severe brain injuries such as cardiac arrest, traumatic brain injury and stroke, mainly including coma, unresponsive wakefulness syndrome/vegetative state (UWS/VS), minimally conscious state (MCS), and emergence from minimally conscious state (EMCS). Transcranial magnetic stimulation (TMS) and transcranial ultrasound stimulation (TUS) have emerged as promising non-invasive neuromodulation techniques. TMS modulates consciousness-related neural networks by regulating cortical excitability, synaptic plasticity, and functional brain network connectivity. Meanwhile, TUS offers superior spatial focality and deep targeting capabilities, enabling intervention in consciousness-related regions such as the thalamus and the thalamocortical circuits. This consensus statement addresses the clinical application of TMS and TUS in both acute and prolonged DoC, providing expert recommendations on key issues including patient selection, pre-treatment assessment, stimulation targets and protocols, efficacy evaluation, and safety management. Furthermore, it outlines future directions involving individualized, multi-target, and closed-loop neuromodulation strategies, aiming to promote the standardized, rational, and safe application of TMS and TUS in the field of DoC.