In Reply We thank Latronico for the comments regarding our article.1 Latronico proposed that peripheral nervous system and muscle pathology2 may have contributed to the lack of behavioral responses exhibited by our patient. As mentioned in our Discussion section, Shea and Bayne3 had previously argued a similar peripheral explanation for the absence of overt motor behavior in patients with preserved covert motor behavior.4 In vegetative and minimally conscious patients, peripheral damage is most commonly related to motor axonal neuropathy,5 which, as Latronico points out, is a major cause of paralysis.2
Fernández-Espejo D, Owen AM. Peripheral Causes of Cognitive Motor Dissociation in Patients With Vegetative or Minimally Conscious State—Reply. JAMA Neurol. 2016;73(5):608–609. doi:10.1001/jamaneurol.2016.0143
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