Regarding why the percentage of bad recovery for patients with GCS motor response score 5 in our study (1/32, 3.2 %) was lower than those in the study by Hifumi et al. (1/4, 25 %), there are three reasons. Firstly, because the number of patients with a GCS motor response score of 5 in the study by Hifumi et al. was only four, a small number, we cannot discuss whether the percentage is high or low, and on the other hand, we also regard the number of patients with bad recovery in the study by Hifumi et al., one, as a small number. In our study, one case with GCS motor response score 5 with Cerebral Performance Category 5 that had not undergone MTH was admitted to the hospital due to malnutrition and died in hospital from an inability to control the primary disease. In this case, it was difficult to believe that MTH would have improved the CPC at 30 days after hospital admission. Secondly, in the study by Hifumi et al., there were multiple different hospital centers each with different inclusion criteria, a different protocol of MTH, and a different capacity of the intensive care unit. These factors resulted in variation in results between sites and a relatively high percentage of bad recovery in patients with GCS motor response score 5. Thirdly, the study by Hifumi et al. included only patients who were treated with MTH. There was no comparison to patients who were treated without MTH, and it is possible that there was no difference in the percentage of good recovery between patients who were treated with MTH and patients who were treated without MTH.