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

Dept of Neurology, Cyclotron Research Centre, University Hospital and University of Liège, Belgium.
BMC Medicine (Impact Factor: 7.25). 11/2010; 8(1):68. DOI: 10.1186/1741-7015-8-68
Source: PubMed


Some 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).
Many 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.
Since 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).

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Available from: Jan Lavrijsen, Oct 06, 2015
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    • "Patients diagnosed with Disorders of Consciousness (DOC), like patients with Unresponsive Wakefulness Syndrome (UWS, [1]) or in Minimally Conscious State (MCS), are characterized by the absence of non-reflexive responses or by intermittent behavioural responsiveness. However, initial functional magnetic resonance imaging (fMRI) studies [2], [3] discovered that such patients, despite the inability to demonstrate voluntary behavioural responses to repeated clinical examinations, are able to wilfully modulate brain activity in response to auditory commands. "
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    ABSTRACT: A promising approach to establish basic communication for disorders of consciousness (DOC) patients, is the application of Brain-Computer Interface (BCI) systems, especially the use of single-switch BCIs (ssBCIs). Recently we proposed the concept of a novel auditory ssBCI paradigm and presented first classification results. In this study we report on the evaluation of four different modifications of the original paradigm with the intention to increase the suitability. Therefore we investigated different sound types and the inclusion of additional spatial information. Finally, the classification investigation with the most encouraging modifications shows an enhancement compared to our original paradigm, within healthy subjects, implicating better results for the future use in DOC patients.
    37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC’15), Milano, Italy; 08/2015
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    • "There are multiple studies using various neuroimaging and electrophysiologic techniques that demonstrate the preservation of a range of neurologic (including cortical) functioning in patients who lack unambiguous behavioral responsiveness. Because of the wealth of evidence suggesting the unreliability of diagnosing lack of awareness , one group, The European Task Force on Disorders of Consciousness, has called for simply abandoning the term " vegetative state " and replacing it with " unresponsive wakefulness syndrome, " so as not to presuppose that patients lacking the ability to behaviorally respond also lack awareness (Laureys et al., 2010). It is worth repeating that this evidence is with respect to patients who show no overt signs of purposeful responsiveness; the 30%– 40% false positive rate refers to patients who do show subtle behavioral signs of awareness that are missed by clinicians. "
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    • "cles with either complete or partial preservation of hypothalamic and brain - stem autonomic functions " ( The Multi - Society Task Force on PVS , 1994 , p . 1500 ) . The nomenclature ' VS ' remains contentious , and the European Task Force on DOC have made a proposal to replace this term with the term ' unresponsive wakefulness syndrome ' ( UWS : Laureys et al . , 2010 ) . However , as ' UWS ' is not yet adopted internationally and is yet to receive recognition from authoritative sources ( Royal College of Physicians , 2013 ) , we use the term ' VS ' in this paper . Individuals who emerge from a VS and demonstrate " minimal but definite evidence " of awareness of themselves or their environments may a"
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    ABSTRACT: Measuring responsiveness to gain accurate diagnosis in populations with disorders of consciousness (DOC) is of central concern because these patients have such complex clinical presentations. Due to the uncertainty of accuracy for both behavioral and neurophysiological measures in DOC, combined assessment approaches are recommended. A number of standardized behavioral measures can be used with adults with DOC with minor to moderate reservations relating to the measures’ psychometric properties and clinical applicability. However, no measures have been standardized for use with pediatric DOC populations. When adapting adult measures for children, confounding factors include developmental considerations for language-based items included in all DOC measures. Given the lack of pediatric DOC measures, there is a pressing need for measures that are sensitive to the complex clinical presentations typical of DOC and that can accommodate the developmental levels of pediatric populations. The Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) is a music-based measure that has been standardized for adults with DOC. Given its emphasis on non-language based sensory stimuli, it is well-suited to pediatric populations spanning developmental stages. In a pre-pilot exploratory study, we examined the clinical utility of this measure and explored trends for test-retest and inter-rater agreement as well as its performance against external reference standards. In several cases, MATADOC items in the visual and auditory domains produced outcomes suggestive of higher level functioning when compared to outcomes provided by other DOC measures. Preliminary findings suggest that the MATADOC provides a useful protocol and measure for behavioral assessment and clinical treatment planning with pediatric DOC. Further research with a larger sample is warranted to test a version of the MATADOC that is refined to meet developmental needs of pediatric DOC populations.
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