“The locked-in syndrome”: Can it be unlocked?

Abstract Locked-in syndrome is one of the most disabling states characterized by the preservation of conscious mind within a quadriplegic and anarthric body. Recently, there has been increased public awareness about this rare condition, and more cases are reported. The commonest causative lesion is bilateral ventral pontine damage secondary to vertebrobasilar artery occlusion. Clinicians need to be familiar with the condition because there is a high chance of erroneous diagnosis, such as coma or vegetative state, after a prolonged unconscious state. It is often the relatives or carers who recognize the conscious state first and report that the patient can communicate through his eyes. Because of complications, such as aspiration and sepsis, about 40–70% of sufferers die in acute phase of illness. However, advancements in medical care, rehabilitation, and communication technology have enabled many chronic locked-in syndrome patients to lead meaningful lives in the society with the help of family and friends.

[1]  C. Anderson,et al.  Life-sustaining treatment and locked-in syndrome , 1993, The Lancet.

[2]  黄亚明.  MedScape , 2009 .

[3]  The 'herald hemiparesis' of basilar artery occlusion. , 1988, Archives of neurology.

[4]  Steven Laureys,et al.  The locked-in syndrome : what is it like to be conscious but paralyzed and voiceless? , 2005, Progress in brain research.

[5]  A. Haig,et al.  Impairment, Activity, Participation, Life Satisfaction, and Survival in Persons With Locked‐In Syndrome for Over a Decade: Follow‐Up on a Previously Reported Cohort , 2003, The Journal of head trauma rehabilitation.

[6]  V Sahgal,et al.  Mortality and complications of the locked-in syndrome. , 1987, Archives of physical medicine and rehabilitation.

[7]  L. Caplan,et al.  Current concepts: Vertebrobasilar disease , 2005 .

[8]  S. Mayer,et al.  Reversal of locked-in syndrome with anticoagulation, induced hypertension, and intravenous t-PA , 2005, Neurocritical care.

[9]  H. Jäger,et al.  Cognitive dysfunction after isolated brain stem insult. An underdiagnosed cause of long term morbidity , 2002, Journal of neurology, neurosurgery, and psychiatry.

[10]  N. Birbaumer,et al.  A brain–computer interface (BCI) for the locked-in: comparison of different EEG classifications for the thought translation device , 2003, Clinical Neurophysiology.

[11]  María del Rosario Domínguez-Morales,et al.  Survey: The locked-in syndrome: a syndrome looking for a therapy , 2002, Brain injury.

[12]  Steven Laureys,et al.  Brain function in coma, vegetative state, and related disorders , 2004, The Lancet Neurology.

[13]  Multi-Society Task Force on Pvs.  Medical aspects of the persistent vegetative state (2). , 1994, The New England journal of medicine.

[14]  J. Ware.  SF-36 health survey: Manual and interpretation guide , 2003 .

[15]  Jean-Dominique Bauby,et al.  The Diving Bell and the Butterfly: A Memoir of Life in Death , 1997 .

[16]  M. Delargy,et al.  Locked-in syndrome , 2005, BMJ : British Medical Journal.

[17]  C. Archer,et al.  Basilar Artery Occlusion Clinical and Radiological Correlation , 1977, Stroke.

[18]  Grant Gillett,et al.  The patient's journey: Living with locked-in syndrome , 2005, BMJ : British Medical Journal.

[19]  F. Plum,et al.  The diagnosis of stupor and coma. , 1972, Contemporary neurology series.

[20]  L. Chia.  Locked‐in syndrome with bilateral ventral midbrain infarcts , 1991, Neurology.

[21]  F. Gerstenbrand,et al.  Varieties of the locked-in syndrome , 1979, Journal of Neurology.

[22]  Y. Péréon,et al.  Persistence of distal motor control in the locked in syndrome. Review of 11 patients , 1995, Paraplegia.

[23]  Multi-Society Task Force on Pvs.  Medical aspects of the persistent vegetative state (1). , 1994, The New England journal of medicine.

[24]  M. Grabois,et al.  Locked-in syndrome: a review of 139 cases. , 1986, Stroke.