This study selected 90 patients with disorders of consciousness after brain injury who were admitted to the Department of Critical Care Rehabilitation, Neurological Rehabilitation, and Neurology at the Third Affiliated Hospital of Zhejiang Chinese Medical University between June 2024 and December 2024. The inclusion criteria were: 1) patients in a coma with a clear history of traumatic brain injury; 2) aged between 18 and 60 years; 3) imaging examinations showing intracranial hemorrhage, subarachnoid hemorrhage, or cerebral contusion; 4) onset within 1 month and a Glasgow Coma Scale (GCS) score between 3 and 8; 5) relatively stable vital signs and no uncontrolled seizures; 6) absence of cervical spinal cord injury, right brachial plexus injury, or median nerve injury; 7) voluntary participation of family members with signed informed consent. The exclusion criteria included: 1) uncontrolled intracranial infections, hydrocephalus, hematoma, or other space-occupying lesions affecting consciousness recovery; 2) patients unable to complete treatment due to various reasons, including severe complications during treatment, transfer to other departments or hospitals, refusal or discontinuation of treatment by family members, or death. This study was approved by the Medical Ethics Committee of the Third Affiliated Hospital of Zhejiang Chinese Medical University (ZSLL-KY-2024-042-01).

Ninety patients were randomly divided into a control group, MNES group, and electroacupuncture group, with 30 patients in each group. There were no statistically significant differences in the general data among the three groups (P > 0.05). See Table 1 .

1) The control group received conventional treatment, including basic therapy combined with comprehensive rehabilitation. Basic therapy: surgical interventions (e.g., external ventricular drainage, decompressive craniectomy), controlled ventilation, sedation and analgesia, intracranial pressure monitoring, intracranial hypertension management, biostasis, hyperbaric oxygen therapy, treatment of traumatic cerebrovascular injury, identification and prevention of post-traumatic seizures, and secondary brain injury management. Comprehensive rehabilitation training: passive limb mobilization (upper and lower extremities), tilt table training, external diaphragm pacing, medical vibration sputum expulsion therapy, pneumatic compression therapy for lower limbs, physical factor therapy, and acupuncture.

2) The MNES group received conventional treatment plus MNES. Conventional treatment included basic therapy and comprehensive rehabilitation (same as the control group). MNES awakening therapy was performed using a median nerve electrical stimulation device (Weisheng Medical Technology Co., Ltd., Nanjing). Method: The stimulating electrode was placed 2 cm above the right wrist crease on the palmar side (median nerve point), and the reference electrode was positioned on the right thenar eminence. Stimulation parameters (based on current research literature) [5] [6] : pulse width of 300 μs, current intensity of 20 mA, frequency of 40 Hz, on-time of 20 s, off-time of 40 s. Slight contraction of the right hand during stimulation indicated satisfactory intensity. Treatment duration: 1 hour daily, 7 days per week, for 4 weeks. All patients were followed up at 30 days via outpatient visit or telephone.

3) The electroacupuncture group received conventional treatment plus electroacupuncture at the Neiguan (PC6) point. Conventional treatment included basic therapy and comprehensive rehabilitation (same as the control group). Electroacupuncture at Neiguan was performed using a median nerve electrical stimulation device (Weisheng Medical Technology Co., Ltd., Nanjing). Method: The right Neiguan point was selected with the patient in a supine position, with the right arm naturally placed beside the body and the palm facing upward. After routine disinfection, a disposable Huatuo acupuncture needle (0.30 mm × 45 mm) was inserted perpendicularly to a depth of approximately 10 mm. The stimulating electrode was connected to the needle handle, and the reference electrode was placed on the right thenar eminence. Stimulation parameters: pulse width of 300 μs, current intensity of 1 mA - 2 mA, frequency of 40 Hz, on-time of 20 s, off-time of 40 s. Slight contraction of the right hand during stimulation indicated satisfactory intensity. Treatment duration: 1 hour daily, 7 days per week, for 4 weeks. All patients were followed up at 30 days via outpatient visit or telephone.

1) Glasgow Coma Scale (GCS) score [7] , assessing eye-opening (max 5 points), verbal response (max 4 points), and motor response (max 6 points). Total scores range from 3 (most severe impairment) to 15 (normal). Lower scores indicate greater severity of consciousness disturbance.

2) Electroencephalogram (EEG) analysis: Common EEG patterns in prolonged coma include δ (1 - 3.5 Hz) and/or θ (4 - 7.5 Hz) waves, focal/diffuse slow waves, intermittent δ rhythms, reduced EEG amplitude, or isoelectric changes. The Young modified classification [8] was used to evaluate EEG activity based on waveform proportion, amplitude, and reactivity.

3) Somatosensory Evoked Potential (SEP): Electrical stimulation of the median nerve recorded cortical/subcortical neural activity, with N20 (short latency) as a key component. Prolonged N20 latency, reduced amplitude, or waveform disappearance correlate with impaired consciousness [9] . N20 changes were monitored to assess recovery.

4) Brainstem Auditory Evoked Potential (BAEP): Reflects functional integrity of the cochlea-brainstem pathway. BAEP alterations (e.g., latency shifts in waves I, III, and V) sensitively indicate brainstem dysfunction [10] . Wave latency changes were tracked to evaluate consciousness recovery.

SPSS 26.0 was used for analysis. Normally distributed quantitative data were expressed as mean ± SD ( $\bar{x}\pm \text{s}$). Intergroup comparisons employed one-way ANOVA (LSD Post-Hoc for homogeneous variance; Satterthwaite test for heterogeneity). Intragroup comparisons using paired t-tests. Kruskal-Wallis H test analyzed ranked data, with the Wilcoxon rank-sum test for pairwise comparisons. Significance was set at P < 0.05.

At admission, there was no statistically significant difference in GCS scores among the three groups (P > 0.05). In the control group, the GCS scores before treatment and after 4 weeks of treatment showed a statistically significant difference (P < 0.05). Similarly, in the MNES group, the GCS scores before treatment and after 4 weeks of treatment exhibited a statistically significant difference (P < 0.05). The electroacupuncture group also demonstrated a statistically significant difference in GCS scores before treatment and after 4 weeks of treatment (P < 0.05). After 4 weeks of treatment, the GCS scores in the electroacupuncture group were higher than those in the control group and the MNES group, with a statistically significant difference (P < 0.05). See Table 2 .

Note: Compared with the same group before treatment, ^aP < 0.05; compared with the control group, ^bP < 0.05; compared with the MNES group, ^cP < 0.05.

At admission, there was no statistically significant difference in EEG results among the three groups (P > 0.05). After 4 weeks of treatment, the proportion of EEG grades I and II in all three groups was higher than before treatment, with a statistically significant difference (P < 0.05). At 4 weeks post-treatment, the electroacupuncture group showed a higher proportion of EEG grades I and II (70%) compared to the control group (33.33%) and the MNES group (50%), with a statistically significant difference (P < 0.05). See Table 3 .

At admission, there was no statistically significant difference in the N20 latency of somatosensory evoked potentials (SEP) among the three groups (P > 0.05). After 4 weeks of treatment, the N20 latency in all three groups was lower than before treatment, with a statistically significant difference (P < 0.05). After 4 weeks of treatment, the N20 latency in the electroacupuncture group was lower than that in the control group and the electroacupuncture group, showing a statistically significant difference (P < 0.05). See Table 4 .

Note: Compared with the same group before treatment, ^aP < 0.05; compared with the control group, ^bP < 0.05; compared with the MNES group, ^cP < 0.05.

At admission, there were no statistically significant differences in the latencies of waves I, III, and V of BAEP among the three groups (P > 0.05). After 4 weeks of treatment, the latencies of waves I, III, and V in all three groups were significantly lower than before treatment (P < 0.05). Post-treatment, the electroacupuncture group showed significantly shorter latencies of bilateral N20 waves I, III, and V compared to both the control group and the electroacupuncture group (P < 0.05). See Table 5 .

Note: Wave I compared to the treatment group before, ^aP < 0.05; compared to the control group, ^bP < 0.05; compared to the MNES group, ^cP < 0.05; Wave III compared to the treatment group before, ^aP < 0.05; compared to the control group, ^bP < 0.05; compared to the MNES group, ^cP < 0.05; Wave V compared to the treatment group before, ^aP < 0.05; compared to the control group, ^bP < 0.05; compared to the MNES group, ^cP < 0.05.