Locked in syndrome, also known as trapped or trapped syndrome, is almost complete paralysis. Those affected are fully conscious and their mental functions are not impaired, but patients can only move their eyes up and down and blink. All other body functions – including breathing – can no longer be controlled independently. Here you will find everything about the definition, symptoms, causes, diagnosis, life expectancy and treatment of locked in syndrome.
Locked in Syndrome – Definition
Locked in syndrome (also: trapped syndrome, locked-in syndrome, LiS for short) is a rare clinical picture in neurology in which those affected can only move their eyes. This makes it possible to communicate by blinking. Patients are fully conscious, meaning they can easily perceive their surroundings and are not mentally impaired. Only all bodily functions are paralyzed. This also affects breathing, which is why patients have to be artificially ventilated and are dependent on comprehensive care around the clock.
Differentiation from vegetative state
Locked in syndrome has many similarities to vegetative state, but differs from vegetative state, among other things, in that people with locked in syndrome are completely paralyzed but remain fully conscious and can often communicate through eye movements. In contrast, individuals in a vegetative state show minimal signs of consciousness but are unable to consciously communicate or respond to their surroundings.
The loss of consciousness in vegetative state can be more profound than in locked-in syndrome, and the prognosis for recovery or improvement of the condition is often different. The causes of vegetative state and locked in syndrome can be similar, with stroke being a common cause, but the degree and type of damage to the brain can result in different symptoms.
Locked in Syndrome – Symptoms
Locked in syndrome is characterized by a characteristic combination of symptoms that occur due to paralysis and the state of consciousness:
- Complete paralysis: Individuals with locked in syndrome are almost completely paralyzed and can perform minimal or no voluntary movements. You are unable to move your arms, legs, or facial muscles, and even breathing may be affected.
- Consciousness and alertness: Although the paralysis is extreme, people with locked in syndrome remain fully conscious and alert. They are able to perceive their surroundings, hear and understand what is happening around them.
- Preserved vertical eye movements: A characteristic feature of locked in syndrome is the preservation of vertical eye movements. This means that patients can usually move both their eyelids and their eyes up and down.
- Impaired horizontal eye movements: While vertical eye movements often remain intact, horizontal eye movements are often impaired or impossible. This means that patients are often unable to move their eyes sideways.
- Limited or Alternate Communication: Due to paralysis are unable to communicate verbally. However, you can use alternative methods of communication such as: B. using eye movements to answer yes or no to questions.
What can patients perceive?
Patients with locked in syndrome are able to perceive their surroundings and conversations around them despite being completely paralyzed. They retain consciousness and can see, hear, smell and feel like a person without the paralysis. They can also experience emotional reactions and often have intact mental awareness. However, the ability to respond to stimuli is severely limited, meaning they may be unable to respond to their environment or express themselves in any other way except through minimal eye movements or other limited forms of communication.
Locked in syndrome – causes
Locked in syndrome has various causes:
A stroke is one of the most common causes of locked in syndrome. An ischemic stroke, caused by the blockage of a blood vessel supply in the brain , can lead to a lack of oxygen and damage to the brain stem . A hemorrhagic stroke, in which bleeding occurs in the brain, can also cause brain damage. Traumatic brain injuries can also cause damage to the brainstem or other areas of the brain.
Brainstem tumors, in turn, damage or compress the surrounding tissue. But treatment of a brainstem tumor can also lead to such damage, especially if the tumor is difficult to access or requires aggressive treatment. Inflammatory diseases of the brain such as multiple sclerosis or certain brain infections can also damage nerve tissue.
In addition, there are severe cases of hypoxia in which the brain does not receive enough oxygen, which can also lead to irreversible damage. Finally, degenerative neurological diseases such as amyotrophic lateral sclerosis (ALS) or certain forms of multiple systemic atrophy also lead to locked-in syndrome in advanced stages.
Locked in Syndrome – Diagnosis
Diagnosing locked in syndrome is challenging because the symptoms are similar to those of other neurological conditions. It therefore requires a careful assessment by a neurologist who will carry out the following examinations:
- Clinical examination: thorough physical examination to detect signs of paralysis, loss of reflexes and other neurological symptoms
- Neurological examination: includes various reflex tests, coordination tests and sensory tests to evaluate the function of the brain and nervous system
- Imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) identify structural changes in the brain
- Electrophysiological tests such as electroencephalography (EEG) or electromyography (EMG) measure the electrical activity of the brain or muscles and identify abnormalities
- Eye movement tests assess communication skills and differentiate locked in syndrome from other conditions
Life expectancy
The life expectancy of people with locked in syndrome can vary greatly. In some cases, people with locked in syndrome can live for many years, while others die from complications or underlying health problems. Early and appropriate medical care and high-quality rehabilitation and care can help improve life expectancy and quality of life.
Locked in Syndrome – Prognosis
The prognosis for people with locked in syndrome depends on several factors, including the underlying cause, the extent of brain damage, the person’s age and general health, and the quality of care and support they receive. Some people may experience improvements in their ability to communicate and quality of life over time, while others may remain stable or worsen.
Locked in syndrome – treatment
Treatment for locked in syndrome focuses on improving patients’ quality of life, supporting their communication skills and promoting their independence. Medical care aims to treat the underlying cause of locked in syndrome and prevent complications. This includes managing high blood pressure, diabetes, or other health conditions.
Rehabilitation plays a crucial role in improving quality of life. Physiotherapy helps improve movement ability and prevent muscle contractures. Occupational therapy helps to gradually promote independence in daily life by developing strategies to cope with everyday activities. Speech and communication therapy helps to learn alternative methods of communication. The use of assistive technology also significantly improves communication and independence, for example eye control systems, speech recognition software or special computers.
Locked in Syndrome – Conclusion
Locked in syndrome is a serious neurological disorder characterized by complete paralysis of the body while being fully conscious. It can be caused by various causes such as strokes, traumatic brain injuries or inflammatory brain diseases. Typical symptoms include complete paralysis except for minimal eye movements, preserved consciousness and alertness, and limited or alternative communication skills. Diagnosis is made through clinical examination, neurological testing, and imaging techniques to rule out other causes. Treatment focuses on improving the patient’s quality of life, supporting their communication skills and providing comprehensive care and support.
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