Article

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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    • "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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    • "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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