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: 7.28). 11/2010; 8(1):68. DOI: 10.1186/1741-7015-8-68
Source: PubMed

ABSTRACT 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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    • "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.
    Frontiers in Psychology 05/2015; 06. DOI:10.3389/fpsyg.2015.00698 · 2.80 Impact Factor
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    • "Functional magnetic resonance imaging (fMRI) studies by Owen et al. (2006) and others Boly et al. (2007), Monti et al. (2010), demonstrating detection of awareness in the unresponsive wakefulness syndrome (UWS, Laureys et al., 2010), paved the way for the development of brain–computer interfaces (BCI) as a means of communication in this patient group. In these studies, patients were asked to imagine playing tennis, or to navigate through their own apartment. "
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    ABSTRACT: Further development of an EEG based communication device for patients with disorders of consciousness (DoC) could benefit from addressing the following gaps in knowledge – first, an evaluation of different types of motor imagery; second, an evaluation of passive feet movement as a mean of an initial classifier setup; and third, rapid delivery of biased feedback. To that end we investigated whether complex and / or familiar mental imagery, passive, and attempted feet movement can be reliably detected in patients with DoC using EEG recordings, aiming to provide them with a means of communication. Six patients in a minimally conscious state (MCS) took part in this study. The patients were verbally instructed to perform different mental imagery tasks (sport, navigation), as well as attempted feet movements, to induce distinctive event-related (de)synchronization (ERD/S) patterns in the EEG. Offline classification accuracies above chance level were reached in all three tasks (i.e. attempted feet, sport, and navigation), with motor tasks yielding significant (p<0.05) results more often than navigation (sport: 10 out of 18 sessions; attempted feet: 7 out of 14 sessions; navigation: 4 out of 12 sessions). The passive feet movements, evaluated in one patient, yielded mixed results: whereas time-frequency analysis revealed task-related EEG changes over neurophysiological plausible cortical areas, the classification results were not significant enough (p<0.05) to setup an initial classifier for the detection of attempted movements. Concluding, the results presented in this study are consistent with the current state of the art in similar studies, to which we contributed by comparing different types of mental tasks, notably complex motor imagery and attempted feet movements, within patients. Furthermore, we explored new venues, such as an evaluation of passive feet movement as a mean of an initial classifier setup, and rapid delivery of biased feedback.
    Frontiers in Human Neuroscience 12/2014; 8:1009. DOI:10.3389/fnhum.2014.01009 · 2.90 Impact Factor
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    • "Detecting signs of consciousness is a challenging task associated with crucial implications such as subsequent care and rehabilitation , and legal and ethical decision-making. Unresponsive wakefulness syndrome (UWS; Laureys et al., 2010) previously referred as vegetative state (VS) is defined by wakefulness without any sign of awareness of self, or the environment (Laureys, 2005). Patients who recover from the UWS/VS will show inconsistent but purposeful behaviors suggesting the presence of conscious awareness. "
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    ABSTRACT: Detecting signs of consciousness in patients in a vegetative state/unresponsive wakefulness syndrome (UWS/VS) or minimally conscious state (MCS) is known to be very challenging. Plotkin et al. (2010) recently showed the possibility of using a breathing-controlled communication device in patients with locked in syndrome. We here aim to test a breathing-based "sniff controller" that could be used as an alternative diagnostic tool to evaluate response to command in severely brain damaged patients with chronic disorders of consciousness (DOC). Twenty-five DOC patients were included. Patients' resting breathing-amplitude was measured during a 5 min resting condition. Next, they were instructed to end the presentation of a music sequence by sniffing vigorously. An automated detection of changes in breathing amplitude (i.e., >1.5 SD of resting) ended the music and hence provided positive feedback to the patient. None of the 11 UWS/VS patients showed a sniff-based response to command. One out of 14 patients with MCS was able to willfully modulate his breathing pattern to answer the command on 16/19 trials (accuracy 84%). Interestingly, this patient failed to show any other motor response to command. We here illustrate the possible interest of using breathing-dependent response to command in the detection of residual cognition in patients with DOC after severe brain injury.
    Frontiers in Human Neuroscience 12/2014; 8:1020. DOI:10.3389/fnhum.2014.01020 · 2.90 Impact Factor
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