Locked-In syndrome

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Locked-In syndrome is a condition in which a patient is aware and awake, but cannot move or communicate due to complete paralysis of nearly all voluntary muscles in the body. It is the result of a brain stem stroke in which the ventral part of the pons (part of the brain stem) is damaged. It results in quadriplegia and inability to speak in otherwise cognitively intact individuals. Those with Locked-In syndrome may be able to communicate with others by coding messages by blinking or moving their eyes, which are not affected by the paralysis.

Locked-in syndrome is also known as Cerebromedullospinal Disconnection, De-Efferented State, Pseudocoma, and ventral pontine syndrome. Unlike persistent vegetative state, in which the upper portions of the brain are damaged and the lower portions are spared, locked-in syndrome is caused by damage to specific portions of the lower brain and brainstem with no damage to the upper brain.

Patients who have Locked-In Syndrome are fully aware. They will know exactly where their arms and legs are, and unlike paralyzed patients, they can still feel sensations of pain and touch. Some patients may have the ability to move certain facial muscles. The majority of locked-in syndrome patients do not regain motor control, but several devices are available to help patients communicate.

Patients with locked-in syndrome report feeling mostly tranquil, and some report feeling a little sad. This is contrary to the panic and terror that would be expected in people who cannot move or speak.

The term is sometimes used to describe other individuals who have minimal voluntary movement by presumably intact cognitive abilities, such as a person with severe cerebral palsy who never developed the ability to move muscles apart from facial muscles, or someone with a spinal cord injury resulting in paralysis from the neck down. It should be noted that a person with a complete spinal cord injury does not have sensation in the affected areas like people with other conditions resulting in paralysis do.

Parisian journalist Jean-Dominique Bauby had a stroke in 1995, and when he awoke 20 days later he found that his body had all but stopped working: he could only control his left eyelid. By blinking his eye he dictated a letter at a time and in this way he wrote The Diving Bell and the Butterfly.

1 Causes
2 Treatment
3 Long Term Recovery
4 References

[edit] Causes

Locked-In syndrome may result for a number of reasons, including:

Traumatic brain injury
Diseases of the circulatory system
Medication overdose
Damage to nerve cells, particularly destruction of the myelin sheath, caused by disease.

[edit] Treatment

There is no standard treatment for Locked-In syndrome, nor is there a cure. Stimulation of muscle reflexes with electrodes (Neuromuscular stimulation) has been known to help patients regain some muscle function. Other courses of treatment are often symptomatic.

[edit] Long Term Recovery

Unfortunately, recovery does not happen in many cases - it is considered extremely rare for motor function to return in any more than a limited fashion.