Corticothalamic dynamics during postictal recovery of self-orientation after electroconvulsive therapy.
Brain Communications January 1, 2026 Sven Stuiver, Prejaas K.b. Tewarie, Julia C M Pottkämper et al.
After a generalized seizure induced by electroconvulsive therapy, recovery of self-orientation—the ability to report one's own identity—depends on restoration of effective communication between the cortex and thalamus. Analysis of 345 EEG recordings from 33 patients showed that immediately after seizure termination, the thalamus suppressed the cortex with minimal intrinsic activity. During recovery, cortical gain decreased while corticothalamic and intrathalamic gains increased, reflecting progressive restoration of thalamic excitatory drive. Self-orientation was regained when model parameters converged to a characteristic regime, with relatively small variability across patients, suggesting a critical threshold for re-emergence of reportable consciousness.