Persistence of distal motor control in the locked in syndrome. Review of 11 patients

Richard, Isabelle; Péreón, Yann; Guiheneu, P; Nogues, B; Perrouin-Verbe, B.; Mathé, J

doi:10.1038/sc.1995.135

Cited by 25 publications

(18 citation statements)

References 29 publications

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“…At that moment, she was transferred to a rehabilitation centre where she made slow but progressive improvement. Her left arm power recovered from distal to proximal muscles, as has been noted in LIS patients (Richard et al, 1995). Head movements were possible and permitted communication.…”

Section: Patient Historymentioning

confidence: 65%

Detecting consciousness in a total locked-in syndrome: An active event-related paradigm

et al. 2009

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Section: Patient Historymentioning

confidence: 65%

Detecting consciousness in a total locked-in syndrome: An active event-related paradigm

et al. 2009

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“…However, motor recovery is futile in a progressive motor neuron disease like ALS and the hope for motor recovery is limited in LIS of vascular origin (Doble et al, 2003). Despite the severe persisting motor deficits in classic LIS, some patients may present improvement (classically showing a distal to proximal progression) and recover voluntary control of head, finger, or foot (Richard et al, 1995;Laureys et al, 2005). Overall, the level of care remains extensive in chronic LIS and patients classically remain dependent on others for activ ities of daily living.…”

Section: Introductionmentioning

confidence: 99%

Life can be worth living in locked-in syndrome

Lulé

Zickler

Häcker

et al. 2009

Progress in Brain Research

183

104

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The locked-in syndrome (LIS) describes patients who are awake and conscious but severely deefferented leaving the patient in a state of almost complete immobility and loss of verbal communication. The etiology ranges from acute (e.g., brainstem stroke, which is the most frequent cause of LIS) to chronic causes (e.g., amyotrophic lateral sclerosis; ALS). In this article we review and present new data on the psychosocial adjustment to LIS. We refer to quality of life (QoL) and the degree of depressive symptoms as a measure of psychosocial adjustment. Various studies suggest that despite their extreme motor impairment, a significant number of LIS patients maintain a good QoL that seems unrelated to their state of physical functioning. Likewise, depression is not predicted by the physical state of the patients. A successful psychological adjustment to the disease was shown to be related to problem-oriented coping strategies, like seeking for information, and emotional coping strategies like denial -the latter may, nevertheless, vary with disease stage. Perceived social support seems to be the strongest predictor of psychosocial adjustment. QoL in LIS patients is often in the same range as in age-matched healthy individuals. Interestingly, there is evidence that significant others, like primary caregivers or spouses, rate LIS patients' QoL significantly lower than the patients themselves. With regard to depressed mood, ALS patients without symptoms focus significantly more often on internal factors that can be retained in the course of the disease contrary to patients with depressive symptoms who preferably name external factors as very important, such as health, which will degrade in the course of the disease. Typically, ALS patients with a higher degree of depressive symptoms experience significantly less ''very pleasant'' situations. The herein presented data strongly question the assumption among doctors, health-care workers, lay persons, and politicians that severe motor disability necessarily is intolerable and leads to end-of-life decisions or euthanasia. Existing evidence supports that biased clinicians provide less-aggressive medical treatment in LIS patients. Thus, psychological treatment for depression, effective strategies for coping with the disease, and support concerning the maintenance of the social network are needed to cope with the disease. Novel communication devices and assistive technology now offers an increasing number of LIS patients to resume a meaningful life and an active role in society.

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“…11 Complete anarthria is secondary to facio-glosso-pharyngo-laryngeal paralysis, also leading to dysphagia and lack of facial expression. 12 Because the supranuclear ocular motor pathways lie more dorsally, there is sparing of the midbrain tectum, leading to communication through eyelid and vertical eye movement. To communicate "yes" can be indicated by one blink or looking up and "no" can be indicated by two blinks or looking down.…”

Section: Clinical Featuresmentioning

confidence: 99%

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

Khanna

Verma

Richard

2011

Journal of Clinical Gerontology and Geriatrics

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a b s t r a c tLocked-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 40e70% 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.

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Persistence of distal motor control in the locked in syndrome. Review of 11 patients

Cited by 25 publications

References 29 publications

Detecting consciousness in a total locked-in syndrome: An active event-related paradigm

Detecting consciousness in a total locked-in syndrome: An active event-related paradigm

Life can be worth living in locked-in syndrome

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

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