Open Access Highly Accessed Debate

Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome

Steven Laureys1*, Gastone G Celesia2, Francois Cohadon3, Jan Lavrijsen4, José León-Carrión5, Walter G Sannita67, Leon Sazbon8, Erich Schmutzhard9, Klaus R von Wild1011, Adam Zeman12, Giuliano Dolce13 and the European Task Force on Disorders of Consciousness1

Author Affiliations

1 Coma Science Group, Dept of Neurology and Cyclotron Research Centre, University Hospital and University of Liège, 4000 Liège, and Belgian National Science Funds, Belgium

2 Dept of Neurology, Loyola University of Chicago, Stritch School of Medicine, 2160 S. First Avenue, Maywood, IL 60153, USA

3 Neurosurgical University Hospital, Pellegrin Tripode, Bordeaux, France

4 Dept of Primary and Community Care, Radboud University Nijmegen Medical Centre Nijmegen, The Netherlands

5 Dept of Experimental Psychology, University of Seville, Spain; Center for Brain Injury Rehabilitation, Torneo 23, Seville, Spain

6 Department of Neuroscience, Ophthalmology and Genetics, University of Genova, Genova, Italy

7 Department of Psychiatry and Behavioral Science, State University of New York, Stony Brook, NY, USA

8 Tel Aviv University, Sackler Medical School, or Former Director of ICU for Vegetative Patients at Loewenstein Rehabilitation Hospital, Israel

9 Dept of Neurology, University Hospital Innsbruck, Austria

10 Medical Faculty, Westphälische Wilhelms-University, Münster, Germany

11 Department of Rheumatology and Rehabilitation, Al-Azhar University, Cairo, Egypt

12 Cognitive and Behavioral Neurology, Peninsula Medical School, Exeter, UK

13 Research on Advanced Neuro-rehabilitation, S. Anna Institute, Via Siris - IT-88900 Crotone, Italy

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BMC Medicine 2010, 8:68  doi:10.1186/1741-7015-8-68

Published: 1 November 2010

Abstract

Background

Some patients awaken from coma (that is, open the eyes) but remain unresponsive (that is, only showing reflex movements without response to command). This syndrome has been coined vegetative state. We here present a new name for this challenging neurological condition: unresponsive wakefulness syndrome (abbreviated UWS).

Discussion

Many clinicians feel uncomfortable when referring to patients as vegetative. Indeed, to most of the lay public and media vegetative state has a pejorative connotation and seems inappropriately to refer to these patients as being vegetable-like. Some political and religious groups have hence felt the need to emphasize these vulnerable patients' rights as human beings. Moreover, since its first description over 35 years ago, an increasing number of functional neuroimaging and cognitive evoked potential studies have shown that physicians should be cautious to make strong claims about awareness in some patients without behavioral responses to command. Given these concerns regarding the negative associations intrinsic to the term vegetative state as well as the diagnostic errors and their potential effect on the treatment and care for these patients (who sometimes never recover behavioral signs of consciousness but often recover to what was recently coined a minimally conscious state) we here propose to replace the name.

Conclusion

Since after 35 years the medical community has been unsuccessful in changing the pejorative image associated with the words vegetative state, we think it would be better to change the term itself. We here offer physicians the possibility to refer to this condition as unresponsive wakefulness syndrome or UWS. As this neutral descriptive term indicates, it refers to patients showing a number of clinical signs (hence syndrome) of unresponsiveness (that is, without response to commands) in the presence of wakefulness (that is, eye opening).