Locked-in syndrome after stroke

The development of intensive care has considerably increased the number of patients surviving severe brain damage. In clinical practice, traumatic and non-traumatic coma is a frequent problem and the main preoccupations of relatives and physicians is the neurologic recovery that may range from absence of cognitive and motor impairments to severe disability or death. The American Congress of Rehabilitation Medicine defined Locked-In Syndrome (LIS) with the presence of sustained eye opening, intact cognitive function, aphonia or severe hypophonia, quadriplegia or quadriparesis and a primery and elementary code of communication that use vertical or lateral eye movement or blinking of the upper eyelid. LIS is typically caused by a ventral pontine lesion of the brainstem. LIS infrequently occurs in children and in adults and patients may wrongly be considered as being in a coma or in vegetative state/unresponsive wakefulness state. In order to avoid this misdiagnosis, our group developed active paradigms in which participants are instructed to voluntarily direct their attention to a target stimulus. Limitations of communication make quality of life assessments in LIS patients particularly difficult. Some physicians who take care of acute LIS or healthy individual may consider that the quality of life of a LIS is very limited. However, studies have shown that patients with severe diseases or motor impairments do not necessarily self-report a poor quality of life.