The locked-in syndrome : what is it like to be conscious but paralyzed and voiceless?

摘要: The locked-in syndrome (pseudocoma) describes patients who are awake and conscious but selectively deefferented, i.e., have no means of producing speech, limb or facial movements. Acute ventral pontine lesions its most common cause. People with such brainstem often remain comatose for some days weeks, needing artificial respiration then gradually wake up, remaining paralyzed voiceless, superficially resembling in a vegetative state akinetic mutism. In acute (LIS), eye-coded communication evaluation cognitive emotional functioning is very limited because vigilance fluctuating eye movements may be inconsistent, small, easily exhausted. It has been shown that more than half the time it family not physician first realized patient was aware. Distressingly, recent studies reported diagnosis LIS on average takes over 2.5 months. cases took 4-6 years before aware sensitive patients, locked an immobile body, were recognized as being conscious. Once becomes medically stable, given appropriate medical care, life expectancy increases to several decades. Even if chances good motor recovery limited, existing eye-controlled, computer-based technology currently allow control his environment, use word processor coupled speech synthesizer, access worldwide net. Healthy individuals professionals sometimes assume quality so poor worth living. On contrary, chronic typically self-report meaningful their demand euthanasia surprisingly infrequent. Biased clinicians might provide less aggressive treatment influence inappropriate ways. important stress only stabilized, informed competent consent refuse life-sustaining treatment. Patients suffering from should denied right die - dignity also, importantly, they live best possible revalidation, pain symptom management. our opinion, there urgent need renewed ethical medicolegal framework care patients.