Locked-In syndrome
From Wikipedia, the free encyclopedia
| Locked-In syndrome Classification and external resources |
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| Locked-In syndrome can be caused by stroke at the level of the basilar artery denying blood to the pons, among other causes. | |
| ICD-10 | G46.3 |
| ICD-9 | 344.81 |
| MeSH | D011782 |
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 lesion in which the ventral part of the pons is damaged. The condition has been described as "the closest thing to being buried alive". In French, the common term is "maladie de l'emmuré vivant", literally translated as walled-in alive disease; in German it is sometimes called "Eingeschlossensein". [1]
Locked-in syndrome is also known as Cerebromedullospinal Disconnection,[2] De-Efferented State, Pseudocoma,[3] and ventral pontine syndrome.
The term for this disorder was coined by Plum and Posner in 1966.[4][5]
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[edit] Presentation
Locked-in syndrome 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 often not affected by the paralysis.
Patients who have locked-in syndrome are conscious and aware with no loss of cognitive function. They can sometimes retain proprioception and sensation throughout their body. Some patients may have the ability to move certain facial muscles, most often some or all of the extraocular eye muscles.
[edit] Causes
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.
Possible causes of locked-in syndrome include:
- Traumatic brain injury
- Diseases of the circulatory system
- Medication overdose
- Damage to nerve cells, particularly destruction of the myelin sheath, caused by disease (e.g. central pontine myelinolysis secondary to rapid correction of hyponatremia).
- A stroke or brain hemorrhage
[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.[6]
Assistive computer interface technologies, such as Dasher may be used to help patients communicate using simple movements such as the blinking of an eye.[1]
New direct brain interface mechanisms may provide future remedies.[7]
[edit] Prognosis
It is extremely rare for any significant motor function to return. The majority of locked-in syndrome patients do not regain motor control, but devices are available to help patients communicate.
[edit] Notable case
Parisian journalist Jean-Dominique Bauby had a stroke in 1995, and when he awoke 20 days later he found that his body was almost completely paralyzed: he could control only his left eyelid. By blinking this eye he dictated a letter at a time and in this way he wrote his memoir The Diving Bell and the Butterfly.[8] The 2007 film The Diving Bell and the Butterfly is a film adaptation of Bauby's memoir.
[edit] Cultural references
- (1844) In Dumas's The Count of Monte Cristo, Monsieur Noirtier de Villeforte becomes locked in after suffering a stroke.
- (1868) In Emile Zola's Thérèse Raquin, Thérèse's aunt Madame Raquin develops locked-in syndrome after a stroke.[9]
- (1939) In Dalton Trumbo's Johnny Got His Gun, Joe Bonham suffers from locked-in syndrome throughout the majority of the story from a devastating shell bombing in WWI.
- (2001) In Bernard Werber's L'ultime Secret (The Ultimate Secret), one of two parallel stories is about the broken life of a modest bank clerk in Nice, Jean-Louis Martin, who is the victim of a car accident and suffers the syndrome.
- (2003-2008) In a series of novels by Jim Kelly, the character Laura suffers from locked-in-syndrome following an automobile accident and subsequent coma. Titles to date are The Water Clock, The Fire Baby, The Moon Tunnel, The Coldest Blood, and The Skeleton Man.
- (2004) CSI NY in season 1, episode 1: "Blink" a man tries to perfect an procedure which locks women in their bodies.
- (2006) Scrubs in season 5, episode 19: "His Story III" the Janitor bonds with a sufferer of locked-in syndrome.
- (1988) The song One (Metallica song) is about locked-in syndrome.
[edit] References
- ^ "Scientists seek to help 'locked-in' man speak", CNN, 14 December 2007
- ^ Nordgren RE, Markesbery WR, Fukuda K, Reeves AG (1971). "Seven cases of cerebromedullospinal disconnection: the "locked-in" syndrome". Neurology 21 (11): 1140–8. PMID 5166219.
- ^ Flügel KA, Fuchs HH, Druschky KF (1977). "[The "locked-in" syndrome: pseudocoma in thrombosis of the basilar artery (author's transl)]" (in German). Dtsch. Med. Wochenschr. 102 (13): 465–70. PMID 844425.
- ^ eMedicine - Stroke Motor Impairment : Article by Adam B Agranoff, MD. Retrieved on 2007-11-29.
- ^ Plum F. and Posner J.B. 1966. The diagnosis of stupor and coma. F.A. Davis Co. Philadelphia, Pennsylvania, USA. 197 pp.
- ^ lockedinsyndrome at NINDS
- ^ Parker, I., "Reading Minds," The New Yorker, January 20, 2003, 52-63
- ^ The Diving Bell And The Butterfly. Retrieved on 2007-11-29.
- ^ Pearce JM (1987). "The locked in syndrome". Br Med J (Clin Res Ed) 294 (6566): 198-9. PMID 3101806.
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