Editing Locked-in syndrome

{{short description|Condition in which a patient is aware but completely paralysed}}
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{{Infobox medical condition (new)
| name            = Locked-in syndrome
| synonyms        = Cerebromedullospinal disconnection,<ref name="pmid5166219">{{cite journal |vauthors=Nordgren RE, Markesbery WR, Fukuda K, Reeves AG | title= Seven cases of cerebromedullospinal disconnection: the "locked-in" syndrome |journal=Neurology |volume=21 |issue=11 |pages=1140–8 |year=1971 |pmid=5166219 |doi=10.1212/wnl.21.11.1140| s2cid= 32398246 }}</ref> de-efferented state, pseudocoma,<ref name="pmid844425">{{cite journal |vauthors=Flügel KA, Fuchs HH, Druschky KF |title=The "locked-in" syndrome: pseudocoma in thrombosis of the basilar artery (author's trans.) |language=de |journal=Deutsche Medizinische Wochenschrift |volume=102 |issue=13 |pages=465–70 |year=1977 |pmid=844425 |doi=10.1055/s-0028-1104912}}</ref> ventral pontine syndrome
| image           = CerebellumArteries.svg
| caption         = Locked-in syndrome can be caused by a stroke at the level of the [[basilar artery]] denying blood to the [[pons]], among other causes.
| field           = [[Neurology]], [[Psychiatry]]
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'''Locked-in syndrome''' ('''LIS'''), also known as '''pseudocoma''', is a condition in which a patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in their body except for vertical eye movements and blinking.<ref>{{cite journal|url=https://www.ncbi.nlm.nih.gov/books/NBK559026|title=Locked-in Syndrome|first1=Joe|last1=Das|first2=Kingsley|last2=Anosike|first3=Ria Monica|last3=Asuncion|date=2022|access-date=10 June 2023|website=[[National Center for Biotechnology Information]]|pmid=32644452 }}</ref> This is due to [[Tetraplegia|quadriplegia]] and [[bulbar palsy]]. The individual is conscious and sufficiently intact cognitively to be able to communicate with eye movements.<ref>{{Cite book|title=motor speech disorders substrates, differential diagnosis, and management|last=Duffy|first=Joseph|publisher=Elsevier|pages=295}}</ref> [[Electroencephalography]] results are normal in locked-in syndrome as these individuals have retained brain activity such as sleep-wake cycles and attention that is detectable.
[[Fred Plum]] and [[Jerome B. Posner]] coined the term for this disorder in 1966.<ref name="titleeMedicine - Stroke Motor Impairment : Article by Adam B Agranoff, MD">{{cite web |url=http://www.emedicine.com/pmr/topic189.htm |title= Stroke Motor Impairment | first = Adam B | last = Agranoff | access-date = 2007-11-29 | work = eMedicine}}</ref><ref>{{Citation | last1 = Plum | first1 = F | last2 = Posner | first2 = JB | year = 1966 | title = The diagnosis of stupor and coma | publisher = FA Davis | place = Philadelphia, PA, USA}}, 197 pp.</ref>

Locked-in syndrome can be separated into different subcategories based on symptom severity.<ref>{{Cite journal |last1=Schnetzer |first1=Laura |last2=McCoy |first2=Mark |last3=Bergmann |first3=Jürgen |last4=Kunz |first4=Alexander |last5=Leis |first5=Stefan |last6=Trinka |first6=Eugen |date=2023-01-01 |title=Locked-in syndrome revisited |journal=Therapeutic Advances in Neurological Disorders |language=EN |volume=16 |pages=17562864231160873 |doi=10.1177/17562864231160873 |issn=1756-2864 |pmc=10064471 |pmid=37006459}}</ref> This consists of classic locked-in syndrome, characterized by the inability to move distal limbs and facial muscles, but retained ability to blink and move eyes vertically, with preserved cognition and consciousness. Incomplete locked-in syndrome is less severe as classic locked-in syndrome and shares similar preserved abilities as classic locked-in syndrome, but has the hallmark of additional motor abilities, whether that be in the muscules innervating the limbs or face. Complete locked-in syndrome contains the conserved cognition and consciousness as classic locked-in syndrome, but has additional motor deficits that render the individual unable to move their eyes vertically or blink. Locked-in plus is an additional form distinguished by impairments to cognition and consciousness, but contains damage to similar regions of the brainstem affected by other forms, notably the pons, with the addition of other cortical and subcortical regions.

==Signs and symptoms==
Locked-in syndrome is usually characterized by loss of limb function and the inability to [[Manner of articulation|speak]] in otherwise cognitively intact individuals. Those with locked-in syndrome may be able to communicate with others through coded messages by blinking or moving their eyes, which are often not affected by the paralysis. Patients who have locked-in syndrome are conscious and aware, with no loss of cognitive function. They can sometimes retain [[proprioception]] and sensation throughout their bodies. Some patients may have the ability to move certain facial muscles, and most often some or all of the [[extraocular muscles]]. Individuals with the  syndrome lack coordination between breathing and voice.<ref name= "fager" />  This prevents them from producing voluntary sounds, though the [[vocal cords]] themselves may not be paralysed.<ref name ="fager">{{cite journal|doi=10.1080/07434610600650318| last1=Fager| first1=Susan| last2=Beukelman| first2=Dave| last3=Karantounis| first3=Renee| last4=Jakobs| first4=Tom| year= 2006| title = Use of safe-laser access technology to increase head movements in persons with severe motor impairments: a series of case reports| journal= Augmentative and Alternative Communication|volume= 22| issue= 3| pages= 222–29 | pmid= 17114165| s2cid=36840057}}</ref>

Individuals with locked-in syndrome also have intact hearing and subsequent language comprehension. However, these patients might have trouble with voluntary breathing and require assistnce due to apnea, ataxia, and hyperpnea. This can be coupled with dizziness and vertigo. Locked-in syndrome patients also have been reported to have involuntary movements such as sucking, chewing, swallowing, yawning, and moaning due to lost pyramidal control of motor systems.<ref>{{Cite journal |last=Bauer |first=G. |last2=Gerstenbrand |first2=F. |last3=Hengl |first3=W. |date=1980-06-01 |title=Involuntary motor phenomena in the locked-in syndrome |url=https://link.springer.com/article/10.1007/BF00313183 |journal=Journal of Neurology |language=en |volume=223 |issue=3 |pages=191–198 |doi=10.1007/BF00313183 |issn=1432-1459}}</ref>

==Causes==
{{More citations needed section|date=June 2024}}
[[Image:Gray760.png|thumb|upright=1.3|In children, the most common cause is a stroke of the ventral [[pons]].<ref name="pmid19748042">{{cite journal  |vauthors=Bruno MA, Schnakers C, Damas F, etal |title= Locked-in syndrome in children: report of five cases and review of the literature |journal=Pediatr. Neurol. |volume=41 |issue=4 |pages=237–46 |date=October 2009 |pmid= 19748042 |doi=10.1016/j.pediatrneurol.2009.05.001 }}</ref>]]
Unlike [[persistent vegetative state]], in which the upper portions of the brain are damaged and the lower portions are spared, locked-in syndrome is essentially the opposite, caused by damage to specific portions of the lower brain and [[brainstem]], with no damage to the upper brain.{{citation needed|date=December 2020}} Injuries to the pons are the most common cause of locked-in syndrome.

Possible causes of locked-in syndrome include:
* [[Poisoning]] cases – More frequently from a [[Bungarus|krait]] bite and other [[neurotoxic]] [[venom]]s, as they cannot usually cross the [[blood–brain barrier]]
* [[Brainstem stroke syndrome|Brainstem stroke]]
* Diseases of the [[circulatory system]]
* Medication overdose{{Example needed |s|date=December 2018}}
* Drug overdose, such as cocaine
* Damage to nerve cells, particularly destruction of the [[myelin sheath]], caused by disease or ''osmotic demyelination syndrome'' (formerly designated [[central pontine myelinolysis]]) secondary to excessively rapid correction of [[hyponatremia]] [>1 mEq/L/h])<ref>{{cite book |language=en |last=Aminoff |first=Michael |title=Clinical Neurology |edition=9nth |year=2015 |page=76 |publisher=Lange |isbn=978-0-07-184142-9}}</ref>
* A stroke or brain hemorrhage, usually of the [[basilar artery]]
* [[Traumatic brain injury]]
* Result from [[lesion]] of the brainstem
* [[Psychological trauma|Trauma]]

[[Curare poisoning]] and [[paralytic shellfish poisoning]] mimic a total locked-in syndrome by causing [[paralysis]] of all voluntarily controlled [[skeletal muscle]]s.<ref>[https://books.google.com/books?id=RSOPDHP9QekC&pg=PA357 Page 357] in: {{cite book |author=Damasio, Antonio R. |title=The feeling of what happens: body and emotion in the making of consciousness |publisher=Harcourt Brace |location=San Diego |year=1999 |isbn=978-0-15-601075-7 |url-access=registration |url=https://archive.org/details/feelingofwhathap00dama_0 }}</ref> The respiratory muscles are also paralyzed, but the victim can be kept alive by [[artificial respiration]].

==Diagnosis==
Locked-in syndrome can be difficult to diagnose. In a 2002 survey of 44 people with LIS, it took almost three months to recognize and diagnose the condition after it had begun.<ref>{{cite journal|last1=León-Carrión|first1=J.|last2=van Eeckhout|first2=P.|last3=Domínguez-Morales Mdel|first3=R.|last4=Pérez-Santamaría|first4=F. J.|title=The locked-in syndrome: a syndrome looking for a therapy|journal=Brain Inj.|date=2002|volume=16|issue=7|pages=571–82|doi=10.1080/02699050110119781|pmid=12119076|s2cid=20970974}}</ref> However, it has reported that it can take upwards of four years to receive a diagnosis<ref>{{Citation |last1=Laureys |first1=Steven |title=The locked-in syndrome : what is it like to be conscious but paralyzed and voiceless? |date=2005 |work=Progress in Brain Research |volume=150 |pages=495–611 |url=https://linkinghub.elsevier.com/retrieve/pii/S0079612305500347 |access-date=2025-05-12 |publisher=Elsevier |language=en |doi=10.1016/s0079-6123(05)50034-7 |isbn=978-0-444-51851-4 |last2=Pellas |first2=Frédéric |last3=Van Eeckhout |first3=Philippe |last4=Ghorbel |first4=Sofiane |last5=Schnakers |first5=Caroline |last6=Perrin |first6=Fabien |last7=Berré |first7=Jacques |last8=Faymonville |first8=Marie-Elisabeth |last9=Pantke |first9=Karl-Heinz}}</ref>.  Locked-in syndrome may mimic [[Unconsciousness|loss of consciousness]] in patients, or, in the case that respiratory control is lost, may even resemble death. People are also unable to actuate standard motor responses such as [[Withdrawal reflex|withdrawal from pain]]; as a result, testing often requires making requests of the patient such as blinking or vertical eye movement.{{citation needed|date=December 2020}}

Brain imaging may provide additional indicators of locked-in syndrome, as brain imaging provides clues as to whether or not brain function has been lost. Additionally, an [[Electroencephalography|EEG]] can allow the observation of sleep-wake patterns indicating that the patient is not unconscious but simply unable to move.<ref name="Merck Manual">{{cite web|last=Maiese|first=Kenneth|url=https://www.merckmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/locked-in-syndrome|title = Locked-in Syndrome|date=March 2014}}</ref> If no mass or vascular lesion is present on the imaging scan, cerebrospinal fluid examination may be used to reveal an infectious or autoimmune root of the symptoms.<ref>{{Citation |last1=Das |first1=Joe M. |title=Locked-in Syndrome |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK559026/ |access-date=2025-05-12 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32644452 |last2=Anosike |first2=Kingsley |last3=Asuncion |first3=Ria Monica D.}}</ref> Similarly, blood tests can detect fluctuations in sodium concentration, that would be indicative of hyponatremia, as well as glucose levels should be monitored to eliminate the possibility of a hypoglycemic coma.

=== Similar conditions ===
* [[Akinetic mutism]]
* [[Unresponsive wakefulness syndrome]]
* [[Minimally conscious state]]
* [[Amyotrophic lateral sclerosis]] (ALS)
* [[Brain tumor|Bilateral brainstem tumor]]s
* [[Brain death]] (of the whole brain or the brainstem or other part)
* [[Coma]] (deep or irreversible)
* [[Guillain–Barré syndrome]]
* [[Myasthenia gravis]]
* [[Poliomyelitis]]
* [[Peripheral neuropathy|Polyneuritis]]
* [[Vegetative state]] (chronic or otherwise)

==Treatment==
Neither a standard treatment nor a cure is available. The best course of treatment consists of stabilizing the patient and then correcting the underlying cause of the lesion or damage. Stimulation of muscle reflexes with electrodes ([[NMES]]) has been known to help patients regain some muscle function. Other courses of treatment are often [[symptomatic]].<ref>{{NINDS|Locked-Syndrome|Locked-in syndrome}}</ref> [[Assistive technology|Assistive computer interface technologies]] such as [[Dasher (software)|Dasher]], combined with [[eye tracking]], may be used to help people with LIS communicate with their environment.{{citation needed|date=December 2020}}

Pulmonary complications are the main cause of death in locked-in syndrome patients, therefore chest physiotherapy like deep breathing exercises, position changes, and postural drainage are of high importance during these acute stages.<ref>{{Cite journal |last1=Papadopoulou |first1=Soultana L. |last2=Dionyssiotis |first2=Yannis |last3=Krikonis |first3=Konstantinos |last4=Lagopati |first4=Nefeli |last5=Kamenov |first5=Ivaylo |last6=Markoula |first6=Sophia |date=2019-09-30 |title=Therapeutic approaches in locked-in syndrome |url=https://foliamedica.bg/article/39425/ |journal=Folia Medica |volume=61 |issue=3 |pages=343–351 |doi=10.3897/folmed.61.e39425 |doi-access=free |pmid=32337919 |issn=1314-2143}}</ref>

==Prognosis==
It is extremely rare for any significant motor function to return, with the majority of locked-in syndrome patients never regaining motor control. However, some people with the condition continue to live for extended periods of time, reported up to a few decades<ref name=esquire1>{{cite news|url=http://www.esquire.com/features/unspeakable-odyssey-motionless-boy-1008 |title=The Unspeakable Odyssey of the Motionless Boy|author= Joshua Foer|work= Esquire |date= October 2, 2008}}</ref><ref>Piotr Kniecicki "An art of graceful dying". Clitheroe: Łukasz Świderski, 2014, s. 73. {{ISBN|978-0-9928486-0-6}}</ref> while in exceptional cases, like that of Kerry Pink,<ref name=BBCnews>{{cite news|url=https://www.bbc.co.uk/news/health-10985836 |title=I recovered from locked-in syndrome|work= BBC Radio 5 Live|author= Stephen Nolan|date= August 16, 2010}}</ref> Gareth Shepherd,<ref name=Dailyecho>{{cite news|url=https://www.dailyecho.co.uk/news/14866880.he-crashed-his-motorbike-and-had-a-stroke-but-hampshire-man-gareth-shepherd-is-back-on-his-feet |title=He crashed his motorbike and had a stroke - but Hampshire man Gareth Shepherd is back on his feet|work=Daily Echo|date=November 8, 2016}}</ref>{{Failed verification|date=December 2024|talk=Gareth Shepherd|reason=Article references Shepherd being comatose, but not having Locked-in syndrome}} Jacob Haendel,<ref name=YouTube>{{cite news|url=https://www.youtube.com/channel/UCpoJxQNKSybRuSXEEuQ0cNA |title=Jacob Haendel Recovery Channel|work= Jacob Handel Recovery|date= June 29, 2020}}</ref> Kate Allatt,<ref name=BBCnews2>{{cite news|url=https://www.bbc.co.uk/news/health-17363584 |title=Woman's recovery from 'locked-in' syndrome|work= BBC News|date= March 14, 2012}}</ref> and Jessica Wegbrans,<ref name=Flinkberoerd>{{cite news|url=https://www.flinkberoerd.nl |title=Het gevecht tegen locked-in|work= Flinkberoerd|date=April 23, 2022}}</ref> a near-full recovery may be achieved with intensive physical therapy. These substantial recoveries in motor movement are thought to be due to potential reorganization of the descending spinal tract pathways. Of those that see improvements in motor functioning, it is thought to be more likely to occur in nonvascular cases of locked-in syndrome compared to vascular patients, as well as distal motor functions being more likely to recover than other facial muscles.<ref>{{Cite journal |last1=Patterson |first1=J R |last2=Grabois |first2=M |date=July 1986 |title=Locked-in syndrome: a review of 139 cases. |url=https://www.ahajournals.org/doi/10.1161/01.STR.17.4.758 |journal=Stroke |language=en |volume=17 |issue=4 |pages=758–764 |doi=10.1161/01.STR.17.4.758 |pmid=3738962 |issn=0039-2499}}</ref><ref>{{Cite journal |last1=Richard |first1=I. |last2=Péreon |first2=Y. |last3=Guiheneu |first3=P. |last4=Nogues |first4=B. |last5=Perrouin-Verbe |first5=B. |last6=Mathe |first6=J. F. |date=November 1995 |title=Persistence of distal motor control in the locked in syndrome. Review of 11 patients |url=https://www.nature.com/articles/sc1995135 |journal=Spinal Cord |language=en |volume=33 |issue=11 |pages=640–646 |doi=10.1038/sc.1995.135 |pmid=8584298 |issn=1476-5624}}</ref>

Although depression has been diagnosed in a subset of patients with locked-in syndrome, literature suggests that many patients still report a significantly high quality life over time and that they are happy, with negative respondents having received their diagnosis relatively recently.<ref>{{Cite journal |last1=Bruno |first1=Marie-Aurélie |last2=Bernheim |first2=Jan L |last3=Ledoux |first3=Didier |last4=Pellas |first4=Frédéric |last5=Demertzi |first5=Athena |last6=Laureys |first6=Steven |date=2011 |title=A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority |journal=BMJ Open |language=en |volume=1 |issue=1 |pages=e000039 |doi=10.1136/bmjopen-2010-000039 |pmid=22021735 |pmc=3191401 |issn=2044-6055}}</ref> This content may derive from their retained consciousness that allows the individual to still experience life and participate in activities they enjoy as well as have obligations in their home life. It is true to say that the degree to which a patient can do is dependent on how severe their symptomology is, but many individuals report leaving the house more than once a month, to where there was ultimately no differences in quality of life between a person with locked-in syndrome and a studied healthy control.<ref>{{Cite journal |last1=Doble |first1=Jennifer E. |last2=Haig |first2=Andrew J. |last3=Anderson |first3=Christopher |last4=Katz |first4=Richard |date=September–October 2003 |title=Impairment, Activity, Participation, Life Satisfaction, and Survival in Persons With Locked-In Syndrome for Over a Decade: Follow-Up on a Previously Reported Cohort |url=https://journals.lww.com/headtraumarehab/abstract/2003/09000/impairment,_activity,_participation,_life.5.aspx |journal=The Journal of Head Trauma Rehabilitation |language=en-US |volume=18 |issue=5 |pages=435–444 |doi=10.1097/00001199-200309000-00005 |pmid=12973273 |issn=0885-9701}}</ref><ref>{{Cite journal |last1=Rousseau |first1=Marie-Christine |last2=Pietra |first2=Stephane |last3=Nadji |first3=Mohammed |last4=Billette de Villemeur |first4=Thierry |date=November 2013 |title=Evaluation of Quality of Life in Complete Locked-In Syndrome Patients |url=https://www.liebertpub.com/doi/10.1089/jpm.2013.0120 |journal=Journal of Palliative Medicine |volume=16 |issue=11 |pages=1455–1458 |doi=10.1089/jpm.2013.0120 |pmid=24215251 |issn=1096-6218}}</ref>

==Research==
New [[brain–computer interface]]s (BCIs) may provide future remedies. One effort in 2002 allowed a fully locked-in patient to answer yes-or-no questions.<ref>[http://www.newyorker.com/magazine/2003/01/20/reading-minds Parker, I., "Reading Minds," The New Yorker, January 20, 2003, 52–63]</ref><ref name="Keiper 2006 4–41">{{cite journal|last=Keiper |first=Adam |title=The Age of Neuroelectronics |journal=New Atlantis (Washington, D.c.) |url=http://www.thenewatlantis.com/publications/the-age-of-neuroelectronics |publisher=The New Atlantis |pages=4–41 |date=Winter 2006 |volume=11 |pmid=16789311 |url-status=dead |archive-url=https://web.archive.org/web/20160212222927/http://www.thenewatlantis.com/publications/the-age-of-neuroelectronics |archive-date=2016-02-12 }}</ref> In 2006, researchers created and successfully tested a neural interface which allowed someone with locked-in syndrome to operate a web browser using an infared camera, navigating a keyboard through selecting letters by blinking or staring at one for a specific period of time.<ref>{{cite journal |vauthors=Karim AA, Hinterberger T, Richter J, Mellinger J, Neumann N, Flor H, Kübler A, Birbaumer N |title=Neural internet: Web surfing with brain potentials for the completely paralyzed  |journal=Neurorehabilitation & Neural Repair |volume=40 |issue=4 |pages=508–515}}</ref> Some scientists have reported that they have developed a technique that allows locked-in patients to communicate via sniffing with nasal pressure being conrted to electrical signals.<ref>{{cite web|url=https://www.science.org/content/article/locked-patients-can-follow-their-noses|title='Locked-In' Patients Can Follow Their Noses|date=26 Jul 2010|publisher=Science Mag|access-date=27 Dec 2016}}</ref>
For the first time in 2020, a 34-year-old German patient, paralyzed since 2015 (later also the eyeballs) managed to communicate through an implant capable of reading brain activity.<ref>{{cite web|url=https://www.technologyreview.com/2022/03/22/1047664/locked-in-patient-bci-communicate-in-sentences/|title=A locked-in man state with ALS has been able to communicate thought alone / MIT Technology Review by Jessica Hamzelou / March 26, 2022}}</ref>

Other communication initiatives have involved utilizing salivary pH as a proxy of yes/no answers, such as by using mental manipulation for a patient train themselves to vary their salivary pH with mental food imagery sich as lemon/milk.<ref>{{Cite journal |last1=Wilhelm |first1=B. |last2=Jordan |first2=M. |last3=Birbaumer |first3=N. |date=2006-08-08 |title=Communication in locked-in syndrome: Effects of imagery on salivary pH |url=https://www.neurology.org/doi/10.1212/01.wnl.0000228226.86382.5f |journal=Neurology |language=en |volume=67 |issue=3 |pages=534–535 |doi=10.1212/01.wnl.0000228226.86382.5f |pmid=16894126 |issn=0028-3878}}</ref> Pupil dialation of a patient at bedside has also been used to signal responses using mental arithmetic.<ref>{{Cite journal |last1=Stoll |first1=Josef |last2=Chatelle |first2=Camille |last3=Carter |first3=Olivia |last4=Koch |first4=Christof |last5=Laureys |first5=Steven |last6=Einhäuser |first6=Wolfgang |date=August 2013 |title=Pupil responses allow communication in locked-in syndrome patients |url=https://linkinghub.elsevier.com/retrieve/pii/S0960982213007021 |journal=Current Biology |language=en |volume=23 |issue=15 |pages=R647–R648 |doi=10.1016/j.cub.2013.06.011|pmid=23928079 |bibcode=2013CBio...23.R647S }}</ref> These options might be especially of use in instances of more severe locked-in syndrome pathology where eye movements are more restricted, or as an immediate precaution that is cost effective before a more personalized brain-computer interface can be developed.
==See also==
* [[Akinetic mutism]]
* [[Paralysis]]
* [[List of people with locked-in syndrome]]
* ''[[The Diving Bell and the Butterfly]]'': memoirs of journalist [[Jean-Dominique Bauby]] about his life with the condition
* ''[[Johnny Got His Gun]]'', novel about a soldier who loses his limbs and senses after being wounded fighting in WWI
* [[One (Metallica song)]], song interpretation of ''[[Johnny Got His Gun (film)|Johnny Got His Gun]]''

==References==
{{Reflist|refs=Locked In Syndrome - NORD (National Organization for Rare Disorders). (n.d.). Retrieved June 28, 2016, from http://rarediseases.org/rare-diseases/locked-in-syndrome/|colwidth=30em}}
25. Injuries to the pons are the most common cause of locked-in syndrome, Harrison’s principles of internal medicine 21st edition vol 2 page 3332.

==Further reading==
* Piotr Kniecicki (2014). ''An Art of Graceful Dying''. Lukasz Swiderski {{ISBN|978-0-9928486-0-6}} (Autobiography, written with residual wrist movements and specially adapted computer)

== External links ==
{{Medical resources
|  DiseasesDB      = 
|  ICD10           = {{ICD10|G|93|8|g|40}} 
|  ICD9            = {{ICD9|344.81}} 
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|  eMedicineSubj   = 
|  eMedicineTopic  = 
|  MeshID          = D011782
}}

{{disorders of consciousness}}
{{Lesions of spinal cord and brainstem}}
{{Authority control}}

{{DEFAULTSORT:Locked-In Syndrome}}
[[Category:Neurotrauma]]
[[Category:Syndromes]]