The locked-in syndrome consists of almost complete paralysis. Awareness and mental function are not affected. People cannot make facial expressions, move, speak, or communicate on their own, but they can move their eyes up and down and blink.
Locked-in syndrome may result from
People with locked-in syndrome cannot move their lower face, chew, swallow, speak, move their limbs, or move their eyes from side to side. They may have difficulty breathing. The disorder resembles coma because people have no obvious way of responding even though they are fully conscious. However, they can move their eyes up and down. If caregivers do not notice the eye movements, people with locked-in syndrome may mistakenly be thought to be unaware of their surroundings and unable to think or communicate. People with this syndrome can learn to communicate by opening and closing their eyes in response to questions.
Whether people recover depends on the cause and its severity. For example, if the cause is a small stroke and people are not completely paralyzed, people may recover enough to do some daily tasks, such as eating and speaking, on their own. If the stroke is large, most people need full-time nursing care permanently.
Because this syndrome can be mistaken for coma, doctors test people who do not move and appear unresponsive by asking them to open and close their eyes. Imaging tests of the brain, such as magnetic resonance imaging (MRI) and computed tomography (CT), are done to determine the cause, particularly to check for any treatable disorders that may be contributing to the problem.
Early treatment involves correcting any conditions that may contribute to the syndrome. Long-term care is the same as that for people in coma (see Long-term care), particularly measures to prevent problems that immobilization can cause, such as pressure sores and permanent stiffening of muscles (contractures). People who have difficulty breathing may need assistance with breathing, such as mechanical ventilation.
People with the locked-in syndrome can learn to communicate using a computer input device controlled by eye movements. Speech therapists can help them develop a communication code using eye blinks. If they recover use of another body part (such as a thumb or the neck), they can communicate in other ways.
Because communication can usually be established, affected people should make their own health care decisions. However, affected people are often very depressed and may need to be advised by a compassionate mental health care practitioner, especially when they are considering future medical interventions and life support measures. If needed, depression is treated.
Last full review/revision March 2013 by Kenneth Maiese, MD