We explain everything you need to know about this neurological syndrome.
Locked-in syndrome is a neurological syndrome that affects mobility , in such a way that the person suffering from it is unable to carry out any type of movement or motor activity. He can’t speak either. Sometimes he can move his eyes vertically.
However, consciousness is preserved and the person can perceive the environment without any difficulty. In this article we will know the symptoms of this syndrome, its causes and possible treatments to apply. We will also differentiate its two stages and the subtypes that exist.
Locked-in syndrome: characteristics
The person who suffers from locked-in syndrome is aware of everything that happens around him; however, he is unable to respond to the stimulation she receives, as he cannot move. There is one exception, however; he can perform eye movements (although not in all cases).
We should not confuse locked-in syndrome with coma or brain death. It is easy for it to happen, since in all three cases there is an absence of motor reactions to stimulation.
Symptoms
Thus, the main symptom of locked-in syndrome is the complete paralysis of the entire body ; one suffers therefore a severe quadriplegia. In addition, over time you can also lose the ability to breathe on your own.
Thus, suffering from this syndrome is something similar to “living in a prison”, the prison being your own body, since consciousness and cognitive functions are practically completely intact. As for the motor capacity, in reality it is preserved; what is altered is the transmission of the orders issued by the brain to the extremities, which are not transmitted.
As a consequence of all this, it is common for significant anxious and depressive symptoms to appear in people with locked-in syndrome.
stages
Locked-in syndrome develops in two stages:
1. First stage
In the first, the person loses their ability to move and articulate any part of the body. In this first phase it is also possible for him to lose consciousness, as well as his basic physiological abilities.
2. Second stage
In the second phase of the syndrome, called the chronic phase, the patient regains consciousness (if it had previously been lost), and also regains the ability to breathe on its own and the ability to make eye movements.
Causes
We are going to see the causes that can originate the locked-in syndrome ; depending on which it is, the syndrome will be transitory or chronic, and the degree of affectation will be greater or lesser. In the event that it is temporary, it will be possible to recover some or even all motor functions.
Thus, locked-in syndrome arises from brain injury; specifically, the lesion occurs in the brainstem. Generally, the affected area is the protuberance of the trunk.
Nerve fibers rupture in this area, causing global motor paralysis. As a result of this rupture, the impossibility of moving the eyes horizontally also occurs in locked-in syndrome, being only possible to move them vertically (and not in all cases).
But what causes the rupture of the fibers of the pons? Usually the origin is a cerebrovascular accident (CVA) or stroke . However, on some occasions the cause can also be a traumatic brain injury (TBI), a tumor, a disease or an overdose caused by some substance (the latter, to a lesser extent).
Types
Depending on the degree of affectation implied by the locked-in syndrome, we can speak of three types of syndromes .
1. incomplete
In incomplete closure it is possible to perform eye movements, as well as some movements with the fingers; you can even get to move your head. The subject is fully aware of what is happening in his environment.
2. Classic
It is the most common; in this case the person can only perform eye movements. Thus, he can move his eyes (only vertically) and blink. As in the previous type, here the subject is also aware of her surroundings.
3. Total
This subtype of locked-in syndrome is the one that is most affected. In this case, the person is unable to perform any type of movement; he can’t even move his eyes. Thus, the gaze remains motionless and totally paralyzed.
As in the other subtypes, the subject remains aware of everything that happens, and their mental and cognitive functions remain intact.
Treatment
There is no treatment to cure locked-in syndrome. However, we do know that there are causes that cause the syndrome temporarily ; In these cases, there is the possibility of recovery and improvements at the motor level.
When a certain treatment can be applied, it is usually aimed at keeping the person alive, ensuring their breathing and eating. Feeding occurs by tube. On the other hand, a physiotherapeutic treatment will be essential to maintain the flexibility of the patient’s muscles and joints.
It will be important to look for alternative communication methods that allow the patient to express himself even if he cannot speak. Some examples are the use of pictograms and taking advantage of the movement of the eyes in the event that it is preserved.
Prevention
In addition, it will be important to apply a preventive treatment to avoid future complications derived from the impossibility of carrying out any motor activity; that is, if the person cannot move, problems such as ulcers and sores can appear.
These arise as a result of the constant contact of the body with certain external areas such as the bed or the chair. In addition, maintaining the same position for so many hours in a row can also cause these types of problems.
At the prevention level, it will also be important, as we have said, to take care of the diet. In addition, the treatment will include the administration of drugs that allow blood to flow throughout the body , preventing the appearance of thrombi.
Bibliographic references
- Centanaro, G. (2004). Guide for the diagnosis of brain death. Neurological Guide, 251-258.
- Lara-Reyna, J.; Burgos-Morales, N.; Achim J.; Martinez, D. and Cardenas, B. (2015). locked-in syndrome. Presentation of a case. Chilean Journal of Neurosurgery, 41.
- Riquelme, V., Errázuriz, J., and González, J. (2011). Locked-in Syndrome: Clinical case and review of the literature. Memoriza.com Magazine, 8: 1-9.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.
