Is there a cartesian renaissance of the mind or is it time for a new taxonomy for low responsive states?

[locked-in syndrome]

The mass media have recently pointed out the likelihood of diagnostic errors in post-coma patients . Late recoveries of consciousness , even after 20 years , might indicate hidden misdiagnoses that are not corrected over a long period of time . The rate of misdiagnoses of patients in a vegetative state is very high when based on behavioral assessment strategies alone . An extremely restrictive motor repertoire , as occurs in locked-in patients , seems to be the major factor responsible for diagnostic confusion . Functional neuroimaging techniques are regarded as promising tools in unearthing covert awareness in behaviorally unresponsive patients who are unable to produce any motor output . However , unless we believe that these patients persistently live in an unconvincing Cartesian-like state , in which thinking and acting are mutually dissociated , we have to admit that a new taxonomy for low responsive states is called for . This taxonomy should take into account the possible syndromic overlap between disorders of consciousness and locked-in syndrome . We should suspect a "locked-in state " in behaviorally unresponsive patients unless we reach strong evidence that such is not the case ; this is the only way to avoid dramatic misdiagnoses .