In the wake coma or apallic syndrome, the affected person can not eat, not drink and barely communicate at all. Nevertheless, they sleep and some also react to stimuli. But many never wake up completely from their twilight sleep.
The eyes open, the facial expressions frozen in a mixture of astonishment and disinterest, unable to move or somehow make contact with the outside world: patients in the coma are less than the shadow of their own. "Apallic syndrome" call physicians this state between the deep Unconsciousness (coma) and the conscious wakefulness of how healthy people experience it. About 3000 to 5000 people fall in Germany every year in a wake coma. Some people manage to fight back into the world of the guards. An estimated 12, 000 dawns permanently.
Death due to food deprivation
In the USA, for example, a patient was deprived of food after many years in a vegetative state, and thus her death sentence was taken. She was tormented, says the husband. She did not feel very bad, say the parents. But who is right, no one will really know. Because if and what is really going on in the consciousness of a coma patient, nobody can say with certainty.
Causes of a wake coma
The cause of the apallic syndrome is often accidents in which the brain was injured. Also, a deficiency of the brain with oxygen - for example, by an anesthesia incident or after a resuscitation after a long cardiac arrest - can cause a person to wake up coma.
The wax coma often joins a real coma. But awakening can not really be talked about. Although these patients breathe without mechanical help. Her sleep-wake-up rhythm is also present. But they are not able to eat or drink and therefore need to be fed artificially.
The term "wake coma" is misleading
Many physicians protect against the term "vegetative coma" because it is a contradiction in terms. The word coma comes from the Greek and means deep powerlessness. "Minimally conscious state": The state of minimal possible consciousness - the English language term - seems more appropriate. Because many patients with the clinical picture of the apallic syndrome react to stimuli of their environment.
In some cases, cerebral current measurements can also prove whether the reaction, for example, when the eyes follow a finger, is pure reflexes, or whether the patient has external stimuli in the cerebral cortex, the center of consciousness and thought, can handle. In healthy people, sentences without meaning in the brain produce a certain pattern on the EEG (electro-encephalogram, recording of brain waves). Such waves can also be measured in some patients in the wake coma.
Glasgow Coma Scale
Consequently, there is not "the" vegetative coma, but rather a multitude of different levels of consciousness in which a person can be. How far a person has moved away from his conscious self is indicated by the numbers on a scale, the so-called "Glasgow Coma Scale".
The doctor evaluates certain clues such as the ability to consciously perform movements or verbally understand. At a GCS score of 3, the individual is in a deep coma, does not respond to anything, and can not respond on its own. A GCS score of 15 equates to a healthy, alert person.
A special case, which still has to be distinguished from the vegetative state, is the so-called Locked-In-Syndrome: people with this disease can not move or speak like comatose patients, but their conscious self is completely intact: this is how Karl-Heinz Pandtke experienced it, a patient from Berlin, aware of how the emergency physicians declared him dead after a stroke involving his cerebellum. He was unable to speak or even blink. He was a prisoner in his own body.
Our consciousness lies in the cerebral cortex: here we think and feel, here our personality is divided into different areas and brain turns. The brain stem, the "oldest" part of our central nervous system (CNS), which evolved much, much earlier in our evolution, controls life support: breathing, sleep, reflexes. In the case of damage to the cerebrum, but the brain stem remains functional, there is an apallic syndrome. The patient is in the vegetative state.
Locked-in syndrome does not affect the cerebrum, or consciousness. However, the cerebrum is beyond the control of the body, externally, this condition is very similar to the coma or wax coma. Often, patients with Locked-In are not recognized as such and, with the mind awake, they must persevere in a motionless body.
Rehabilitation in the wake coma
The sooner a patient can begin rehabilitation, the greater the chances of recovery, or at least the improvement of the condition. The more comprehensive the care, the better. Relatives should talk a lot with the patient, help with care, and show how to properly handle the coma or ward com puter. Even small signals such as raising an eyebrow or twitching with your finger can be the first signs of the awakening of consciousness. Often, however, months pass before first successes can be seen.
The rehabilitation and care of a patient in a vegetative state financially goes into the thousands of euros per month. Many health insurances pay only to a certain point and thus give many people the opportunity to progress back towards normalcy.
Burden on relatives
But not only financially is the family members required a lot. Taking care of a loved one who is in such a helpless situation is a tremendous physical and often physical burden, especially if home care is provided. In self-help groups and counseling centers, they can find help and talk to other stakeholders. Traumatic Brain Patients in Not eV even offers an emergency telephone.