About de-efferented state

What is de-efferented state?

Locked-in syndrome is a rare neurological disorder in which there is complete paralysis of all voluntary muscles except for the ones that control the movements of the eyes. Individuals with locked-in syndrome are conscious and awake, but have no ability to produce movements (outside of eye movement) or to speak (aphonia). Cognitive function is usually unaffected. Communication is possible through eye movements or blinking. Locked-in syndrome is caused by damaged to the pons, a part of the brainstem that contains nerve fibers that relay information to other areas of the brain.

What are the symptoms for de-efferented state?

Cannot consciously or voluntarily chew symptom was found in the de-efferented state condition

Individuals with locked-in syndrome classically cannot consciously or voluntarily chew, swallow, breathe, speak, or produce any movements other than those involving the eyes or eyelids. Some affected individuals can move their eyes up and down (vertically), but not side-to-side (horizontally). Affected individuals are bedridden and completely reliant on caregivers. Despite physical paralysis, cognitive function is unaffected.

Individuals with locked-in syndrome are fully alert and aware of their environment. They can hear, see and have preserved sleep-wake cycles. Affected individuals can communicate through purposeful movements of their eyes or blinking or both. They can comprehend people talking or reading to them.

Individuals with locked-in syndrome often initially are comatose before gradually regaining consciousness, but remain paralyzed and unable to speak.

Clinical forms The locked-in syndrome may be classified in three different clinical forms, according to the traditional classification of Bauer. This classification is based on the amount of motor outputs, which are preserved in the patients. It talks about a pure form when the patient loses the control of all body movements with the exception of blinking and vertical eye movements; an incomplete form when some voluntary movements other than eye movements are preserved and a total form when a complete loss of motor function occurs. The last condition is particularly dramatic as the patients are completely unable to interact with the environment and to express their needs and thoughts.

Quality of life Although the locked-in syndrome appears as the most dramatic form of motor disability one can imagine, some scientific reports indicate that the quality of life of patients is not so poor as expected. A recent survey investigated the self-reported quality of life of chronic patients with locked-in syndrome and concluded that many patients have a happy and meaningful life, especially when proper social services help patients to have a normal role at home as well as in the community.

Additional symptoms under investigation Patients with locked-in syndrome are traditionally considered cognitively intact as all the cerebral structures with the exception of the ventral portion of the pons of the brain are apparently preserved. However, recent evidence suggests that the patients can develop some non-motor symptoms including motor imagery defects, pathological laughter and crying, and difficulties in the recognition of some facial expressions. The interruption of the cortico-ponto-cerebellar pathways, by means of the the same lesion causing the locked-in syndrome, may be responsible for the appearance of these clinical manifestations. However, these symptoms are not detected in all affected individuals and are currently under further investigation. The recognition of motor imagery defects deserves special attention because these symptoms, whenever present, may interfere with the success of rehabilitation strategies.

What are the causes for de-efferented state?

Locked-in syndrome is most often caused by damage to a specific part of the brainstem known as the pons. The pons contains important neuronal pathways between the cerebrum, spinal cord and cerebellum. In locked-in syndrome there is an interruption of all the motor fibers running from grey matter in the brain via the spinal cord to the body’s muscles and also damage to the centers in the brainstem important for facial control and speaking.

Damage to the pons most often results from tissue loss due to lack of blood flow (infarct) or bleeding (hemorrhage) – less frequently it can be caused by trauma. An infarct can be caused by several different conditions such as a blood clot (thrombosis) or stroke. Additional conditions that can cause locked-in syndrome include infection in certain portions of the brain, tumors, loss of the protective insulation (myelin) that surrounds nerve cells (myelinolysis), inflammation of the nerves (polymyositis), and certain disorders such as amyotrophic lateral sclerosis (ALS).

What are the treatments for de-efferented state?

Treatment should first be aimed at the underlying cause of the disorder. For example, reversal of a basilar artery blood clot (thrombosis) with intraarterial thrombolytic therapy may be attempted up to six hours after symptoms onset. Tumors may be treated with intravenous steroids or radiation.

Affected individuals often need an artificial aid for breathing and will have a tracheotomy (a tube going in the airway via a small hole in the throat) in the beginning.

Feeding and drinking will not be possible via the mouth (it may cause respiratory infection by running into the lungs rather than stomach) and hence will need to be assured via a small tube inserted in the stomach called gastrostomy.

It is important to establish an eye-coded communication as soon as possible. Healthcare providers and family and friends should try to find out what is the easiest code for the affected individual and consequently all use the same code. This can be ‘look up’ for ‘yes’ and ‘look down’ for no or whatever is the easiest movement for the specific case. Communication is then limited to closed yes-no questions and can next be replaced by eye-coded letter spellers such as saying the alphabet and having the affected individual look down to choose her or his letter. There are many variations on this way of communication presenting the letters in frequency of use in the English language or using letter boards with different columns and lines for vowels and consonants for example.

Next, treatment should be aimed at the early rehabilitation of the small voluntary movements that remain or recover (often in a finger or foot or swallowing and sound production). Rehabilitation and various supportive therapies are very beneficial and should be started as early as possible even if it needs to be stressed that recovery of near-normal motor control, speaking, swallowing and walking are extremely unusual.

Devices to aid in communication and other assistive technologies have proven beneficial as well as allowing individuals to become active members of society. Infrared eye tracking devices now permit affected individuals to use a computer with artificial voice, control their environment, surf on the internet and send email. In rare cases, some individuals have recovered limited motor abilities, however, in most people such recovery does not occur. Those who recover some motor control in hand or head (as will over half of the patients) can use this to communicate with a computer and sometimes control their wheelchair.

Recent studies and articles in the medical literature have noted that despite significant motor disability affected individuals can retain a good quality of life. In addition, quality of life is unrelated to the degree of physical impairment. With advances in care and assistive technologies, individuals with locked-in syndrome can become productive members of society.

What are the risk factors for de-efferented state?

De-efferented state is also named locked-in syndrome. It is a very rare neurological disorder. In this disorder, there occurs full paralysis of all the voluntary muscles, but only the muscle that controls the movements of the eyes is not affected. The person who is suffering from this disease is alert and conscious, and awake, but they are unable to produce any type of movement, or they are unable to speak. They can only communicate by moving their eyes or blinking. When there is damage to the pons, that time de-efferented state occurs.

1. Pons are the part of the brainstem that has nerve fibers, giving information to other areas of the brain.
2. The damage to the pons results in loss of tissue due to lack of blood flow or hemorrhage i.e. bleeding.
3. This disorder does not allow a person to chew, swallow, breathe, or speak properly. Only one can move their eyes vertically but not horizontally. Because of paralysis, a person is completely dependent and reliable on others.
4. Patients are also at risk of developing non-motor symptoms like motor imagery defects, pathological laughter, crying and sometimes difficulty in recognizing faces.
5. Not all, but only a few of the patients experience these conditions.
6. Also, conditions such as infection in some parts of the brain, tumors, loss of protective insulation, inflammation of the nerves, and disorders such as amyotrophic lateral sclerosis can be due to de-efferented states.

Symptoms
Cannot consciously or voluntarily chew, swallow, breathe, speak, or produce any movements other than those involving the eyes or eyelids,Individuals can move their eyes up and down (vertically), but not side-to-side (horizontally),Bedridden and completely reliant on caregivers. Despite physical paralysis, cognitive function is unaffected
Conditions
A neurological disorder in which there is complete paralysis of all voluntary muscles except for the ones that control the movements of the eyes
Drugs
Therapies

Is there a cure/medications for de-efferented state?

De-efferented state is also named locked-in syndrome. It is a very rare neurological disorder. In this disorder, there occurs full paralysis of all the voluntary muscles, but only the muscle that controls the movements of the eyes is not affected. The person who is suffering from this disease is alert and conscious, and awake, but they are unable to produce any type of movement, or they are unable to speak. They can only communicate by moving their eyes or blinking. When there is damage to the pons, that time de-efferented state occurs. Pons are the part of the brainstem that has nerve fibers, giving information to other areas of the brain. The damage to the pons results in loss of tissue due to lack of blood flow or hemorrhage i.e. bleeding. This disorder does not allow a person to chew, swallow, breathe, or speak properly. Only one can move their eyes vertically but not horizontally. Because of paralysis, a person is completely dependent and reliable on others.

Cure/medications for De-efferented state-
1. Firstly, eye-coded communication is important to establish.
2. All the members of the family, and caretakers must create the same code that is suitable and understandable for the patient.
3. Rehabilitation and certain therapies are essential and should be started immediately.
4. For communication, certain devices also prove to be beneficial.
5. This helps the affected person to be socially active. Infrared eye tracking devices help the person to use a computer with artificial voice, control their environment, surf on the internet, and send an email.

Symptoms
Cannot consciously or voluntarily chew, swallow, breathe, speak, or produce any movements other than those involving the eyes or eyelids,Individuals can move their eyes up and down (vertically), but not side-to-side (horizontally),Bedridden and completely reliant on caregivers. Despite physical paralysis, cognitive function is unaffected
Conditions
A neurological disorder in which there is complete paralysis of all voluntary muscles except for the ones that control the movements of the eyes
Drugs
Therapies

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