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Isolation syndrome: causes, symptoms, diagnosis, treatment

Alexey Kryvenko, medical expert
Last reviewed: 05.07.2025

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Locked-in syndrome (synonyms: deeffenentation state, locked-in syndrome, ventral pontine syndrome, awake coma) is a condition with preserved wakefulness and orientation with loss of facial expressions, movements, and speech. Communication is possible only through eye movements.

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What causes isolation syndrome?

Isolation syndrome develops as a result of a stroke affecting the pons with damage to the centers involved in providing horizontal gaze.

Symptoms of Isolation Syndrome

Cognitive functions are not impaired, the patient is conscious, can open his eyes, sleep and be awake, but is unable to move the lower half of the face, chew, swallow, speak, breathe, and move his limbs. The patient can move his eyes vertically and blink a specified number of times in response to questions.

Diagnosis of isolation syndrome

The diagnosis is made mainly on the basis of the clinical picture. Neuroimaging can help determine the cause of the condition and track its dynamics over time. EEG is normal during wakefulness and sleep.

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Treatment of isolation syndrome

Most patients die within a month; recovery to independence is rare but may occur within a few months if the cause is partially reversible (e.g., severe generalized paralysis in Guillain-Barré syndrome). Positive prognostic signs include early recovery of horizontal eye movements and the appearance of evoked motor responses to transcranial magnetic stimulation of the motor cortex. Survival in isolation for up to 18 years has been reported.

Therapy is aimed at preventing pneumonia, urinary tract infections, etc., providing good nutrition, preventing bedsores, and performing physical exercises to prevent the development of contractures. Speech therapists can help establish contact using blinking or eye movement cues. Since the cognitive sphere is preserved, the patient is able to make decisions about continuing treatment independently.