Cortical processing modulation in DOC by preferred music-coupled 40 Hz binaural stimulation: an exploratory EEG-fNIRS study

ObjectiveTo determine if 40 Hz binaural beat therapy (BBT) combined with preferred music enhances neural complexity and connectivity in disorders of consciousness (DOC).MethodsIn a randomized controlled trial, 40 patients with DOC, including minimally conscious state (MCS) and vegetative state/unresponsive wakefulness syndrome (VS/UWS), received either daily 40 Hz BBT with preferred music (n = 21) or standard rehabilitation (n = 19). Primary outcomes included Coma Recovery Scale-Revised (CRS-R) scores, electroencephalography (EEG)-based approximate entropy (ApEn), cross-ApEn (C-ApEn), and functional near-infrared spectroscopy (fNIRS)-based average functional connectivity (FC) of functional connectivity (HbO).ResultsBoth groups showed CRS-R improvements (p < 0.05). The 40 Hz BBT group demonstrated significant enhancement in prefrontal pole of ApEn (p < 0.05, Cohen’s d = 0.65), central-prefrontal pole of C-ApEn (p < 0.05, Cohen’s d = 0.56), and average FC of HbO (p < 0.05, Cohen’s d = 0.86), with moderate to large effect sizes. In contrast, the control group showed smaller and non-significant effect sizes for these measures (Cohen’s d = 0.27, 0.40). These effects were absent in VS/UWS patients of the 40 Hz BBT music therapy group. The prefrontal pole of ApEn correlated strongest with clinical outcomes (R = 0.342, p = 0.031).ConclusionThe findings suggest that 40 Hz BBT combined with preferred music may enhance neural complexity and functional connectivity in patients with DOC, though these effects were not observed in VS/UWS patients receiving the 40 Hz BBT music therapy.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2300079310.