Effects of Xingnao Kaiqiao Acupuncture on Brain Functional Connectivity in Patients with Prolonged Disorders of Consciousness

Objective To investigate dynamic changes in brain functional connectivity (FC) in patients with prolonged disorders of consciousness (pDOC) during and after Xingnao Kaiqiao(XNKQ) acupuncture therapy using functional near-infrared spectroscopy (fNIRS). Methods 36 patients with pDOC were enrolled. After one patient was excluded because of data quality issues, the final analysis included 35 patients who completed the acupuncture intervention with fNIRS monitoring. fNIRS assessments of changes in oxygenated hemoglobin (HbO) concentration were conducted before, during, and after XNKQ acupuncture sessions. Intra- and interregional FC analyses were performed across eight predefined regions. FC analysis was performed by extracting HbO time series before, during, and after acupuncture. Results Compared with the baseline FC, FC was significantly greater during acupuncture. Subgroup analysis revealed increased FC during acupuncture in patients with unresponsive wakefulness syndrome (UWS). In contrast, no such increase was detected in individuals in the minimally conscious state (MCS) or in the sham acupuncture group. The intraregional FC in the left frontal lobe (LFL), right frontal lobe (RFL), left temporal lobe (LTL), and left dorsolateral prefrontal cortex (LDLPFC) markedly increased during acupuncture. FC remained elevated in the LFL, RFL, LTL, right temporal lobe (RTL), and right primary motor cortex (RPMC) after acupuncture. The interregional FC between the LFL-LTL, LFL-RFL, LFL-RTL, RFL-LTL, RFL-RTL, and LTL-RTL was significantly greater during acupuncture. These enhancements persisted after acupuncture for LFL-LTL, LFL-RFL, RFL-LTL, RFL-RTL, and LTL-RTL FC. In the UWS subgroup, the intraregional FC in the LFL, RFL, LTL, RTL, and LDLPFC, as well as the interregional FC between the LFL and LTL, increased during acupuncture. After acupuncture, FC was increased in the LFL, LTL, and RPMC. In the MCS subgroup, FC in the RFL was elevated after acupuncture. Additionally, interregional FC between the LFL and RFL increased both during and after acupuncture, and connectivity between the RFL and LFL also increased following acupuncture. Conclusion XNKQ acupuncture selectively increases FC in consciousness-related networks, particularly within frontal and temporal cortices, with sustained effects postintervention. These findings support the therapeutic potential of XNKQ for pDOC patients through targeted reorganization of higher-order cognitive networks, providing neurophysiological evidence for its clinical application.