Exploring the prognostic value of resting state brain activity in Disorders of Consciousness: A coordinate-based...

The prognostic value of spontaneous brain activity in patients with Disorders of Consciousness (DoC) remains questionable due to methodological heterogeneity, small sample sizes, and the difficulty in conducting longitudinal studies on this clinical population. We performed a coordinate-based meta-analysis of the studies adopting resting state brain imaging techniques to identify whether the spontaneous activity of specific brain areas has a prognostic value for DoC patients. We included studies published until 2025 providing the peak coordinates deriving from contrasting brain activations of patients showing full consciousness recovery (Good Outcome;GO) and patients showing either no consciousness recovery or death (Bad Outcome; BO) with voxel-wise whole-brain analyses. Twelve studies were included in the meta-analysis containing data from 332 DoC patients (n = 192 BO) in the post-acute phase, assessed through resting state functional Magnetic Resonance Imaging. Compared to BO, GO patients showed increased spontaneous activity in sensory and associative areas, including visual areas, precuneus, temporo-parietal, and, marginally, premotor regions. Taken together, the results suggest preservation of posterior brain areas is pivotal in assisting prognosis, with a marginal role played by the premotor areas. However, both low-level sensory and high-level associative areas contribute to outcome prediction of DoC patients, possibly due to the need to integrate low-level sensory information to enable functional interaction with the environment.