BackgroundSome patients awaken from coma (that is, open the eyes) but remain unresponsive (that is, only showing reflex movements without response to command). This syndrome has been coined vegetative state. We here present a new name for this challenging neurological condition: unresponsive wakefulness syndrome (abbreviated UWS).DiscussionMany clinicians feel uncomfortable when referring to patients as vegetative. Indeed, to most of the lay public and media vegetative state has a pejorative connotation and seems inappropriately to refer to these patients as being vegetable-like. Some political and religious groups have hence felt the need to emphasize these vulnerable patients' rights as human beings. Moreover, since its first description over 35 years ago, an increasing number of functional neuroimaging and cognitive evoked potential studies have shown that physicians should be cautious to make strong claims about awareness in some patients without behavioral responses to command. Given these concerns regarding the negative associations intrinsic to the term vegetative state as well as the diagnostic errors and their potential effect on the treatment and care for these patients (who sometimes never recover behavioral signs of consciousness but often recover to what was recently coined a minimally conscious state) we here propose to replace the name.ConclusionSince after 35 years the medical community has been unsuccessful in changing the pejorative image associated with the words vegetative state, we think it would be better to change the term itself. We here offer physicians the possibility to refer to this condition as unresponsive wakefulness syndrome or UWS. As this neutral descriptive term indicates, it refers to patients showing a number of clinical signs (hence syndrome) of unresponsiveness (that is, without response to commands) in the presence of wakefulness (that is, eye opening).

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Average responses to clicks were recorded from the exposed human cortex of 19 adult patients during operation for the treatment of intracranial diseases. Auditory evoked responses were obtained from two areas. Short latency potentials were recorded on the superior surface of the temporal lobe corresponding to the transverse temporal gyri. These responses consisted of two positive waves P1 and P2 separated by a negative wave N1. P1 had a mean latency of 14-7+/-1-5 ms, N1 a mean latency of 19-1+/-2-6 ms and P2 a mean latency of 32-2+/-4-1 ms. Responses to stimulation of the contralateral ear were of higher amplitude than responses to stimulation of the ipsilateral ear. Responses of smaller amplitude and longer latency were obtained from the superior temporal gyrus and the upper lip of the sylvian fissure. These responses had a mean peak latency for P1 of 40-2+/-2-6 ms, for N1 of 62-5+/-12-5 ms and for P2 of 97-7+/-17-2 ms. It is concluded that the cortical auditory region of man may be subdivided in two major areas: an area on the supratemporal plane representing the primary auditory area or A1 and a region surrounding A1 which perhaps comprises two areas, one on the superior temporal gyrus and one on the upper bank of the sylvian fissure including frontal and parietal operculi.

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