Faculty Opinions recommendation of Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome.

Consciousness requires wakefulness and awareness. Many neuropsychiatric syndromes involve the disturbance of these functions. This chapter provides an overview of the various clinical presentations involving quantitative or qualitative disturbances of consciousness in order to explore the associated pathologies and underlying neurophysiological mechanisms. It lays out a number of clinical syndromes associated with impaired consciousness, such as persistent vegetative state (PVS) or unresponsive wakefulness syndrome (UWS), where the patient’s bodily functions can continue independently and show activity in higher motor areas when prompted under functional magnetic resonance imaging, yet are unable to communicate or follow commands. Focus is then given to altered mental states where conditions, such as neuroleptic malignant syndrome (NMS), may cause patients to experience depersonalization, fugue states, and hallucinations. After exploring the neuroanatomy and neurophysiology of such disorders, with a description of the function and significance of the ascending reticular activating system (ARAS), a number of clinical scenarios are presented.

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Predicting outcome from subacute unresponsive wakefulness syndrome or vegetative state

Critical Care ◽

10.1186/cc13831 ◽

2014 ◽

Vol 18 (2) ◽

pp. 132 ◽

Cited By ~ 3

Author(s):

Olivier Bodart ◽

Steven Laureys

Keyword(s):

Vegetative State ◽

Unresponsive Wakefulness Syndrome ◽

Predicting Outcome

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Zolpidem Action During Prolonged Disorders of Consciousness (Case Report)

General Reanimatology ◽

10.15360/1813-9779-2019-5-44-60 ◽

2019 ◽

Vol 15 (5) ◽

pp. 44-60 ◽

Cited By ~ 1

Author(s):

E. A. Kondratyeva ◽

M. V. Sinkin ◽

E. V. Sharova ◽

S. Laureys ◽

A. N. Kondratyev

Keyword(s):

Vegetative State ◽

Minimally Conscious State ◽

Conscious State ◽

Disorders Of Consciousness ◽

Eeg Monitoring ◽

Unresponsive Wakefulness Syndrome ◽

Favorable Prognosis ◽

Eeg Activation ◽

Minimally Conscious ◽

Electroencephalogram Eeg

The paper describes two patients with prolonged disorders of consciousness (PDC) because of non-traumatic brain injury, in whom a clear neurodynamic response to Zolpidem was observed.In order to illustrate systemic cerebral responses to administration of this drug in LIC patients, an analysis of clinical and electrophysiological changes has been undertaken.It has been shown that the result of Zolpidem applications in patients with prolonged disorders of consciousness (PDC) should be assessed not only by consciousness dynamics, but with the help of electroencephalogram (EEG) monitoring, too. Distinct response to Zolpidem during different periods of recovery in one patients was found.Zolpidem can render various effects in patients in vegetative state/with unresponsive wakefulness syndrome (VS/UWS) and in minimally conscious state (MCS). In one patient, sedation with EEG activation was observed, which was a sign of favorable prognosis. The other patient developed more than once local convulsions after Zolpidem administration followed by contact augmentation on the next day.The mechanism of action, necessary doses of drugs, and markers of forecasting the successful effect of that drug are yet to be further studied.

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Public Perception of the Vegetative State/Unresponsive Wakefulness Syndrome: A Crowdsourced Study

10.20944/preprints201812.0082.v1 ◽

2018 ◽

Cited By ~ 1

Author(s):

Daniel Kondziella ◽

Man Cheung Cheung ◽

Anirban Dutta

Keyword(s):

Public Perception ◽

Vegetative State ◽

Treatment Withdrawal ◽

Unresponsive Wakefulness Syndrome ◽

Functional Magnetic Resonance ◽

The Public ◽

Common Mean ◽

Ethical Implications ◽

Brain Injured ◽

Sizeable Minority

Background: The vegetative state (VS)/unresponsive wakefulness syndrome (UWS) denotes brain-injured, awake patients who are seemingly without awareness. Still, up to 15% of these patients show signs of covert consciousness when examined by functional magnetic resonance imaging (fMRI) or EEG, which is known as cognitive motor dissociation (CMD). Most experts prefer the term unresponsive wakefulness syndrome to avoid the negative connotations associated with vegetative state and to highlight the possibility for CMD. However, the perception of VS/UWS by the public has never been studied systematically. Methods: Using an online crowdsourcing platform, we recruited 1297 participants from 32 countries. We investigated if vegetative state and unresponsive wakefulness syndrome might have a different influence on attitudes towards VS/UWS and CMD. Results: Participants randomized to be inquired about the vegetative state believed that CMD was less common (mean estimated frequency in unresponsive patients 38.07% ± SD 25.15) than participants randomized to unresponsive wakefulness syndrome (42.29% ± SD 26.63; p=0.016). Attitudes towards treatment withdrawal were similar. Most participants preferred unresponsive wakefulness syndrome (60.05%), although a sizeable minority favored vegetative state (24.21%; difference 35.84%, 95% CI 29.36 to 41.87; p<0.0001). Searches on PubMed and Google Trends revealed that unresponsive wakefulness syndrome is increasingly used by academics but not lay people.Discussion: Simply replacing vegetative state with unresponsive wakefulness syndrome may not be fully appropriate given that 1 of 4 prefer the first term. We suggest that physicians take advantage of the controversy around the terminology to explain relatives the concept of CMD and its ethical implications.

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