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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    • "Therefore, recognizing the subtle difference between unresponsive wakefulness syndrome (UWS) patients (where patients " awaken " from a coma, meaning they open their eyes, but only show reflex behavior, formerly known as vegetative state or apallic syndrome; Laureys et al., 2010) and minimally conscious state (MCS) patients (who show nonreflex movement, e.g., visual fixation or pursuit, localization to pain or following simple commands like " look up " and " squeeze my hand " ; Bruno et al., 2011; Giacino et al., 2002) requires repeated evaluations by skilled examiners. Furthermore, it is relatively easy to confuse UWS and locked-in syndrome patients (LIS; Plum and Posner, 1971) who are fully conscious but completely paralyzed except for small movements of the eyes or eyelids. "
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    • "Clinical research in severely brain injured patients with disorders of consciousness (DOC) is trying to understand the neural causes and failing mechanisms of consciousness (Laureys, et al., 2004; Laureys and Schiff, 2012; Owen, et al., 2009). One of the most severe DOC, the vegetative state (VS, also called unresponsive wakefulness syndrome (UWS) (Laureys, et al., 2010)), manifests itself as the persistence of arousal, wakefulness and rest cycles, respiration, and autonomic control, but without external signs of awareness (Ashwal and Cranford, 1995; Laureys, et al., 2010). In VS/UWS, a metabolic dysfunction as measured by 18F- fluorodeoxyglucose positron emission tomography (FDG-PET) was found mostly in a wide frontoparietal network encompassing polymodal associative cortices (Kinney and Samuels, 1994; Teasdale and Jennett, 1974; Teasdale, et al., 1983; Thibaut, et al., 2012). "
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    • "Patients with disorders of consciousness (DOC) are a patient population that is very difficult to assess. Following coma, these patients can be in an unresponsive wakefulness syndrome (UWS) where behavior is reflexive, and awareness of the self and surrounding is absent (The Multi-Society Task Force of Pvs, 1994; Laureys et al., 2010), or in a minimally conscious state (MCS) where behaviors indicating awareness are limited, fluctuating but reproducible (Giacino et al., 2002). Various interferences, both physical and cognitive impairments, or medical complications can affect the diagnosis based on clinical assessments of consciousness (Schnakers et al., 2009). "
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