Abstract

LOCKED-IN SYNDROME: CAUSES, DIAGNOSIS AND ITS MANAGEMENT

Mohammad Gayoor Khan*, Yezdani Umama, Ganga Prasad Dangi, Ahshan Khan, Shorav Rav and Arvind Verma

ABSTRACT

Locked-in syndrome is a rare neurological disorder(pseudo coma) in which a patient is aware of all things around him but is complete paralyses of voluntary muscles in all parts of the body except of those that control eye movement and blinking.[1] This may result from a traumatic brain injury, diseases of circulatory system, diseases that destroy the myelin sheath which surrounds the nerve cells, or overdose of medications. Locked-in syndrome usually results from quadriplegia and the inability to speak in cognitively intact individuals. The symptoms of this are similar to those of paralysis. These kinds of patients are conscious and aware, with no loss of cognitive function. In which the upper portions of the brain are damaged and the lower portions are not, locked-in syndrome is caused by damage to specific portions of the lower brain and brainstem, with no damage to the upper brain. Brainstem or infarct; rarely other causes such as trauma, or infection.[2] Its diagnosis can be done by blinking or vertical eye movement.ECG in these kinds of patients is normal. Brain imaging provides clear indicators of locked-in syndrome, as it provides clues as to whether or not brain function has been lost. In addition to it, an EEG can allow the observation of sleep-wake patterns indicating that the patient is not unconscious but simply unable to move. Electromyography and nerve conduction study used for knowing the damage to the muscles and nerves. An MRI, MR angiography and electromyography is a test which records electrical activity in the skeletal (voluntary) muscles at rest and during muscle contraction can be used.[4] The management of this can be done by a therapy called functional neuromuscular stimulation, which uses electrodes to stimulate muscle reflexes, may help activate some paralyzed muscles. Several devices to help communication are available. Providing patient with good nutrition and preventing them with ulcers and other type of infections is the only way to treat it.[1] Avoiding lifestyles that lead to coronary artery disease which can result in strokes may prevent locked-in syndrome in some patients; this syndrome is rare.

Keywords: Pseudo coma, quadriplegia, traumatic brain injury, electro myopathy lifestyle changes etc.