Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome

Abstract

BackgroundSome patients awaken from coma (that is, open the eyes) but remain unresponsive (that is, only showing reflex movements without response to command). This syndrome has been coined vegetative state. We here present a new name for this challenging neurological condition: unresponsive wakefulness syndrome (abbreviated UWS).DiscussionMany clinicians feel uncomfortable when referring to patients as vegetative. Indeed, to most of the lay public and media vegetative state has a pejorative connotation and seems inappropriately to refer to these patients as being vegetable-like. Some political and religious groups have hence felt the need to emphasize these vulnerable patients' rights as human beings. Moreover, since its first description over 35 years ago, an increasing number of functional neuroimaging and cognitive evoked potential studies have shown that physicians should be cautious to make strong claims about awareness in some patients without behavioral responses to command. Given these concerns regarding the negative associations intrinsic to the term vegetative state as well as the diagnostic errors and their potential effect on the treatment and care for these patients (who sometimes never recover behavioral signs of consciousness but often recover to what was recently coined a minimally conscious state) we here propose to replace the name.ConclusionSince after 35 years the medical community has been unsuccessful in changing the pejorative image associated with the words vegetative state, we think it would be better to change the term itself. We here offer physicians the possibility to refer to this condition as unresponsive wakefulness syndrome or UWS. As this neutral descriptive term indicates, it refers to patients showing a number of clinical signs (hence syndrome) of unresponsiveness (that is, without response to commands) in the presence of wakefulness (that is, eye opening).

Divergent neural responses to narrative speech in disorders of consciousness

“…Subscale scores from each patient's highest CRS‐R and command following data from functional neuroimaging were assessed by an expert neurologist (senior author NS) to codify clinical diagnoses of VS, MCS−/+, or eMCS according to the following criteria: patients may remain wakeful but unresponsive to the external world in the persistent VS 30. Others in the MCS may have inconsistent responses to their surroundings 31.…”

From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness

“…This resulted in last years' introduction by the European Task Force on Disorders of Consciousness of the term unresponsive wakefulness syndrome [11]. Their reasons for calling these patients unresponsive rather than vegetative were multiple.…”

Correlation between resting state fMRI total neuronal activity and PET metabolism in healthy controls and patients with disorders of consciousness

“…One of the most severe DOC, the vegetative state (VS, also called unresponsive wakefulness syndrome (UWS) (Laureys et al. 2010)), manifests itself as the persistence of arousal, wakefulness and rest cycles, respiration, and autonomic control, but without external signs of awareness (Ashwal and Cranford 1995; Laureys et al. 2010).…”

“…2010)), manifests itself as the persistence of arousal, wakefulness and rest cycles, respiration, and autonomic control, but without external signs of awareness (Ashwal and Cranford 1995; Laureys et al. 2010). In VS/UWS, a metabolic dysfunction as measured by 18F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) was found mostly in a wide frontoparietal network encompassing polymodal associative cortices (Teasdale and Jennett 1974; Teasdale et al.…”