"Locked-in" syndrome

Locked-in syndrome revisited

The locked-in syndrome (LiS) is characterized by quadriplegia with preserved vertical eye and eyelid movements and retained cognitive abilities. Subcategorization, aetiologies and the anatomical foundation of LiS are discussed. The damage of different structures in the pons, mesencephalon and thalamus are attributed to symptoms of classical, complete and incomplete LiS and the locked-in plus syndrome, which is characterized by additional impairments of consciousness, making the clinical distinction to other chronic disorders of consciousness at times difficult. Other differential diagnoses are cognitive motor dissociation (CMD) and akinetic mutism. Treatment options are reviewed and an early, interdisciplinary and aggressive approach, including the provision of psychological support and coping strategies is favoured. The establishment of communication is a main goal of rehabilitation. Finally, the quality of life of LiS patients and ethical implications are considered. While patients with LiS report a high quality of life and well-being, medical professionals and caregivers have largely pessimistic perceptions. The negative view on life with LiS must be overthought and the autonomy and dignity of LiS patients prioritized. Knowledge has to be disseminated, diagnostics accelerated and technical support system development promoted. More well-designed research but also more awareness of the needs of LiS patients and their perception as individual persons is needed to enable a life with LiS that is worth living.

Recurrent syncope and quadriplegia

A 72-year-old man had posturally induced syncopal episodes, followed by quadriparesis, coma, and death. Neuroimaging studies supported the clinical diagnosis confirmed by neuropathological findings.

Recovery in non-vascular locked-in syndrome during treatment with Sinemet

A case of successful pharmacological therapy of non-vascular locked-in syndrome (LIS) is described. A 22-year-old male experienced aqueductal stenosis following an episode of viral meningitis 11 months prior to admission. A ventriculo-peritoneal shunt was inserted and subsequently revised three times. Following the last procedure, the patient remained mute, quadriplegic and aphagic. There was no change in the patient's status for 9 days. Bromocriptine (2.5 mg daily) was begun and increased to 45 mg daily without any change in PECS scores. It was then tapered and Sinemet (75/300 daily) was begun and increased to 75/750 daily. The PECS scores in all areas rose steadily during the subsequent 6 weeks. Sinemet may be of value in the rehabilitation therapy of non-vascular LIS; serial patient evaluation by a PECS system may facilitate assessment of the response.