Even if the chances of good motor recovery are very limited, existing eye-controlled, computer-based communication technology currently allow the patient to control his environment, use a word processor coupled to a speech synthesizer, and access the worldwide net. Once a LIS patient becomes medically stable, and given appropriate medical care, life expectancy increases to several decades. In some cases it took 4-6 years before aware and sensitive patients, locked in an immobile body, were recognized as being conscious. Distressingly, recent studies reported that the diagnosis of LIS on average takes over 2.5 months. It has been shown that more than half of the time it is the family and not the physician who first realized that the patient was aware. In acute locked-in syndrome (LIS), eye-coded communication and evaluation of cognitive and emotional functioning is very limited because vigilance is fluctuating and eye movements may be inconsistent, very small, and easily exhausted. People with such brainstem lesions often remain comatose for some days or weeks, needing artificial respiration and then gradually wake up, but remaining paralyzed and voiceless, superficially resembling patients in a vegetative state or akinetic mutism. Acute ventral pontine lesions are its most common cause. The locked-in syndrome (pseudocoma) describes patients who are awake and conscious but selectively deefferented, i.e., have no means of producing speech, limb or facial movements.
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