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December 1979

'Locked-in Syndrome' in Postinfective Polyneuropathy

Author Affiliations

Department of Neurology University of Maryland School of Medicine Baltimore, MD 21201

Arch Neurol. 1979;36(13):860. doi:10.1001/archneur.1979.00500490074017

To the Editor.—  Carroll and Mastaglia1 reported a case of "locked-in coma" in a middle-aged man with postinfective cranial and peripheral polyneuropathy in the January issue of the Archives. Their patient had bulbar paresis and a flaccid tetraparesis, but he was alert and responded appropriately. Over a 24-hour period, complete paralysis of all cranial nerves and all peripheral musculature developed. Despite this de-efferented state, the EEG taken at that time of unresponsiveness recorded an 8-s alpha rhythm as well as minimal attenuation to passive eye opening. By day 14 of his illness, the patient had regained enough jaw and neck movement to resume nonverbal communication. Over the next months, he made a substantial recovery with no cognitive deficit. The authors refer to this case as an example of "alpha coma," despite admitting that there was little concrete evidence of central brainstem dysfunction. They recommended performing evoked potentials in similar