Fig. 5: Optimal functional connectivity and alignment with brain networks disrupted in other consciousness-impairing conditions.

A The DBS improvement network was derived by comparing the functional connectivity of stimulation sites between improved and non-improved groups using normative resting-state fMRI data^40,41. The resulting map shows unthresholded t-scores, where positive values indicate regions with stronger connectivity in the improved group, and negative values indicate stronger connectivity in the non-improved group. Cortical surfaces are displayed on the fs_LR_32k template (https://balsa.wustl.edu/QXj2), and subcortical anatomy is shown using the BigBrain histological atlas¹⁰⁴ registered to MNI space¹⁰⁵. The unthresholded map is available in GIfTI format at: https://osf.io/bjah5. Analyses included patients with successful nonlinear image registration to MNI space (n = 10 improved, n = 18 non-improved). B We assessed whether the DBS improvement network was associated with arousal outcomes in an independent cohort of 45 patients with arousal-impairing stroke lesions^23,42. Axial slices show lesion frequency. For each lesion, a whole-brain connectivity map was computed, and its spatial similarity to the DBS improvement network was correlated with behavioral arousal ratings (6-point ordinal scale; lower scores = greater impairment). The scatter plot shows a significant association (two-sided Spearman correlation), with a linear fit and 95% confidence interval overlaid. C We further compared the DBS improvement network to brain regions showing BOLD signal changes during generalized spike-wave discharges in 15 patients with absence epilepsy scanned using simultaneous EEG-fMRI^43,44,45. An example EEG trace recorded inside the MRI scanner is shown using a longitudinal bipolar montage, with channels grouped by region: R1 = right lateral (Fp2-F8, F8-T4, T4-T6, T6-O2); L1 = left lateral (Fp1-F7, F7-T3, T3-T5, T5-O1); R2 = right parasagittal (Fp2-F4, F4-C4, C4-P4, P4-O2); L2 = left parasagittal (Fp1-F3, F3-C3, C3-P3, P3-O1); M = midline (Cz-Pz); E = electrocardiogram. EEG-fMRI results are displayed as z-score maps, where positive values indicate BOLD increases during discharges, and negative values indicate decreases. The histogram shows results from spin-permutation testing (10,000 spins)⁴⁶, revealing a significant negative correlation (two-sided Spearman correlation) between the EEG-fMRI map and the DBS improvement network. Source data are provided as a Source Data file. Conn. connectivity, EEG electroencephalogram, ECG electrocardiogram, Func. functional, L left, Lat. lateral, Med. medial, Perm. permutations, R right.