For professionals

Abstract

Background
Some patients wake up from a coma (that is, open the eyes) but become unresponsive (that is, they only show reflex movements with no response to command). This syndrome is called the vegetative state. Here we present a new name for this challenging neurological disorder: unresponsive wakefulness syndrome (UWS for short).

Discussion
Many clinicians are uncomfortable referring to patients as vegetative. Indeed, for most of the lay public and the media, vegetative state has a pejorative connotation and it seems inappropriate to refer to these patients as vegetable. Some political and religious groups have therefore felt the need to emphasize the rights of these vulnerable patients as human beings. In addition, an increasing number of functional neuroimaging and cognitively evoked potential studies since the first description more than 35 years ago have shown that physicians should be cautious about making strong claims about consciousness in some patients without behavioral responses to command. Given these concerns about the negative associations inherent in the term vegetative state, as well as the diagnostic errors and their possible effect on the treatment and care of these patients (who sometimes never restore behavioral signs of consciousness, but often recover to what was recently called a minimally conscious state), we propose here to replace the name.

Conclusion
Since the medical community has failed to change the pejorative image of the words vegetative state after 35 years, we think it would be better to change the term itself. We offer doctors here the possibility to refer to this condition as unresponsive wakefulness syndrome or UWS. As this neutral descriptive term indicates, it refers to patients who show some clinical signs (hence syndrome) of non-response (i.e. unresponsive to commands) in the presence of vigilance (i.e. opening the eyes).