Persistent Vegetative State vs. Locked-in Syndrome

Many have vaguely heard of these two scary brain conditions – both sequelae to extensive brain damage.  What does it mean when a loved one is diagnosed with locked-in syndrome, or in a persistent vegetative state?  And how do they differ from one another?

These two conditions are somewhat opposites. Many confuse them. In Persistent Vegetative State (PVS), the person may open his eyes, but is not aware of his environment.  In Locked-in Syndrome (LIS), the person is fully aware of his environment, but cannot talk or move.

To fully understand them, you’ll need to remember two brain structures:

(1) The cerebral cortex (upper brain):  responsible for consciousness, awareness, cognition, reasoning, speech

(2) The brain stem (lower brain): the part of the brain that keeps you alive!  It maintains breathing, houses the cranial nerves and contains nerve pathways that connect your upper brain to the spinal cord.

For a thorough review of human brain anatomy, read this article:
Parts of the Brain – Simplified

Persistent Vegetative State
“Awake but not Aware”

A persistent vegetative state occurs when, after a coma,  a patient wakes up but has lost upper brain function.  Since their brain stem is fully intact, they can usually breathe on their own, open their eyes, and have some involuntary  actions.  These actions, however, are NOT conscious or voluntary.

Causes: Damage to the upper brain (cerebral cortex).  The upper brain is responsible for consciousness, awareness, cognition, reasoning, speech — thinking abilities in general.  The lower brain (brain stem) is intact.

People in persistent vegetative states CAN:

  • breathe on their own
  • open and move their eyes (some can even track objects with their eyes)
  • have regular sleep-wake cycles
  • cry, laugh, smile, moan, scream spontaneously (not related to external stimulus)
  • move their limbs slightly (only as a reflex)

People in persistent vegetative state CANNOT:

  • speak
  • understand his environment
  • perform any voluntary action such as follow commands
  • move his body beyond reflexive actions, such us raise his arms

Locked-in Syndrome
“Conscious but Cannot Move”

The film "The Diving Bell and the Butterfly" illustrates locked-in syndrome

Locked-in syndrome is a condition in which a person is completely conscious and aware of his environment, but cannot move due to complete paralysis of all voluntary muscles in the body except for the eyes. In fact, there’s a version called total locked-in
syndrome where the eyes are paralyzed as well.  It’s considered the closest experience someone can have to being “buried alive.”

Cause: Damage to the anterior portion of the pons, which is part of the brain stem.  The ventral or anterior portion of the pons contains majority of the motor nerve tracts that control voluntary movement.  Since the brain stem also controls breathing and circulation, some locked-in patients have trouble breathing on their own.
The upper brain (cerebral cortex) is intact.

People with Locked-in Syndrome CAN:

  • understand his environment
  • perceive and process thought like any other person
  • feel pain and other regular sensations
  • have normal sleep-wake patterns
  • (mostly) move their eyes, track objects and blink

People with Locked-in Syndrome CANNOT:

  • speak
  • move his body
  • (occasionally) cannot even move his eyes

A brilliant French movie about Locked-In Syndrome was made in 2007 called The Diving Bell and the Butterfly.  It tells the real life story of Jean-Dominique Bauby – from his stroke, his locked-in diagnosis, and how he was able to write an entire book by just blinking one eye.  Highly, HIGHLY recommended!

Hopefully this entry helps family and friends understand and differentiate Persistent Vegetative State and Locked-in Syndrome.  Both conditions are devastating to family, and in the case of LIS, exponentially more devastating to the patient!  And remember:

  1. PVS and LIS are NOT coma.  In coma, the person does not wake up at all
  2. PVS and LIS patients are NOT brain dead.  In brain death, there is absence of total brain function, not just part of it.  To learn more about brain death, read this entry: How to Determine Brain Death
102 Comments Post a Comment
  1. Donia Schloot says:

    I remember right after I came down with the brain lesion, I was so terrified of going to sleep because it had made so exhausted beyond what I had experienced before. I was so scared that I would wake up trapped in a body that would not work. It was such a scary experience. Reading about it sure makes me squirm. I never had so much fear before the lesion occurred. Since it was such a very real possibility, my fear of Locked-In-Syndrome only intensified after I came down with the brain lesion. I could write a book about my experiences…. LOL! Oh, by the way, I have been deaf since birth.

  2. Kath says:

    I’m glad you lived through it, Donia. I’m very sure any brain lesion, injury or damage must be very frightful. And Locked-In-Syndrome is the absolute worst thing that can happen to anyone, IMO.

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  7. Katrina says:

    It should also be noted that there is a version of LIS called “Incomplete Locked-In Syndrome” wherein the patient does have some other movement besides the eyes. Others may progress to this stage after therapy. People with LIS have also been known to say the occasional word.

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  9. David says:

    Can a person whose spouse is in a permanent vegetative state obtain a quick civil divorce? I am hoping to do so when our child will be 18, in a little over 3 years, so there won’t be a minor child, and we don’t have any joint property…just want to get on with my life (it’s been almost a dozen years already, and will be 15 years then). And, which states have the minimum residency requirement to obtain a civil divorce in such a situation?

    • Joe says:

      I don’t think that you bringing the subject of divorcing someone with the condition is very appropriate in this blog. If you want the answer to your question you should be asking a divorce attorney. Although I am sympathetic to you situation and understand it is a difficult thing to be going through. This blog is meant to be informative of these conditions.

  10. nisitha says:

    this is a very helpful article. I’m a medical student’ was looking for the difference between p.v.s. n l.I.s. highly recommend.

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    • Tekno says:

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    • Meyat says:

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    • Shalsa says:

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    • Angel says:

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    • Shekhar says:

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      Glad to hear your skies are sunning up, Mike. And yeah, peparhs we should remind each other about how these project lists grow and then somehow overtake our lives can your tomatoes and peppers forgive you for not having a hoop house? Probably. But yeah, if I can say anything about them they are very easy to construct.Teresa, of course after I wrote this it’s not rained a drop. Sheesh. Otherwise I would send it your way!! But yeah here’s hoping you’re at least blight-free this summer.Amy, I was walking around the gardens yesterday and indeed raised beds can be very efficient. Especially if you augment the soil with lots of organic stuff, you might even be able to crowd things in quite a bit, and if you succession-crop and interplant the productivity per square foot goes way up. I do like doing things in quadrants so I can rotate groups of plants as families so that there’s less chance of a bug or a blight hitting the same crop twice. Anyway, consolidation is great!Rachelle, that sounds like a decent solution. I have had three approaches to the paths: nothing, then cardboard/wood chips, then grass clippings on top of them, then even more wood chips. The chips are rotting away nicely thus there’s weeds again. Grr. Need about 20 yards of chips (two dumptruck loads) to really be efficient need to look into the local tree service to see if I can score some this fall. And see Dennis’ and Amy’s comments above to benefit from their experience Shannon! That sounds like you have low pollination. You can attempt to do it yourself with a cotton swab: find the male flowers (they’re the ones without a fruit blob attached to it right at the stem) and do a dusting then transfer it to the female flowers, doing the same swabbing thing. Can you encourage the native pollinators like mason bees? I just got a mason bee house for my birthday, it’s pretty sweet. And also put lots of flowers in and around your veg and that can help.Heidi, indeed. Who knew those little things were such a bit of a pain. I figured I am growing a seed crop this year, so that next year I can have and shell maybe one small meal of them. Kind of makes me laugh, considering how much I love garbanzos and lentils: I would need a LOT of time if I attempted self-sufficiency in them. But a greenhouse in SD? That would be fun, but you’re right, not terribly necessary in paradise, eh?Jules, tomatoes are mostly self-pollinating, which is one of the reasons I have success with them in the greenhouses: I would just wait and see, unless of course you see dead blossoms with nothing attached, then, well, I dunno. That squash plant is probably toast, though. I have heard you can wrap the stem with tinfoil from below the soil to about a foot out to prevent borers. I did a tutorial last year about extraction; you need a knife, and to keep an eye out for the signs.Emily, I guess the Netherlands has Ontario beat as far as square feet of indoor growing space. Apparently they even light and heat the things. I suppose they’d need to because they’re so far north but wow. Anyway, good eye!Hi Niki. I did try the augment-the-beds thing before I resorted to the drain pipe and that’s when we got the most rain and I lost practically everything. Do you know how gross rotten carrots are? Believe me, nasty. It’s funny. Our garden space has been the kitchen garden as long as there’s been a house here (nearly 100 years) and it was placed where it was so that it would retain the water. Hum, bad idea. Thus, I dug. Fortunately, these things don’t need to be far down, just as deep as the shovel itself (the pipe is 4 diameter, about $30 for 100 ) and if you go over it with a tiller first it’s even easier. But raised beds DO help, just not for deep-rooted crops like carrots or even broccoli which just hates wet feet.Sara! Just think how fun it will be in the Wisco winter!! If it’s any consolation we put both of ours up in the fall, and the newer one even got snow on the crops before the plastic got put up.Serina, well, they are wimpy plants, that’s for sure. I don’t think they like the heat much which I find hilarious: aren’t they middle eastern? I’d think it was hotter there than here. But yeah: I was always pro-tree before I became a serious gardener, and now well. Firewood!Dennis, that’s my experience with the school gardens in particular. Don’t get me started on quack grass. Nasty stuff. Thanks for your input!Amy, sand! Hah. Oh boy I hate sand more than clay. I grew up in the sand dunes, the stuff was everywhere, always, but indeed it does mean you can pull them weeds out quickly. Emily, there’s a whole school of thought about forest-gardening (it’s an extreme form of permaculture) that you are practicing with the unraised parts of your garden, did you know that? I would love to practice it but my experience is that the weeds do win out and darn it it’s always at the expense of our preferred plants. Gardening with extreme prejudice, that’s what I do, I guess. But psst: here’s a secret: if things get really bad with clover or whatever I even whip out the tiller down a bed row then I swear it won’t happen again!! Anyway, try grass clippings as mulch it does help.

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      I’m hoping that Obama will act for the best inrteests of truth and justice. The US must stop ships constantly, just as Israel did, so I am hopeful that he will see that this situation was caused by these terrorists intent on violence against Israel. I know that each one of the soldiers was injured and some of them hurt very badly, but I am surprised that any of these soldiers survived, -They did due to their very young ages and their military training, I believe

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