Evelyne Mélotte1,2, Audrey Maudoux3,4, Sabrina Delhalle4, Charlotte Martial3, Georgios Antonopoulos3, Stephen Karl Larroque3, Sarah Wannez3, Marie-Elisabeth Faymonville5, Jean-François Kaux6, Steven Laureys3, Olivia Gosseries3, Audrey Vanhaudenhuyse3,5. 1. Physical and Rehabilitation Medicine Department, University Hospital of Liege, Liège, Belgium. Evelyne.melotte@chuliege.be. 2. GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium. Evelyne.melotte@chuliege.be. 3. GIGA Consciousness, Coma Science Group and Neurology Department, University and University Hospital of Liege, Liège, Belgium. 4. Otorhinolaryngology Head and Neck Surgery Department, University and University Hospital of Liege, Liège, Belgium. 5. Hypnosis and Pain GIGA Center and Algology and Palliative Care Department, University and University Hospital of Liege, Liège, Belgium. 6. Physical and Rehabilitation Medicine Department, University Hospital of Liege, Liège, Belgium.
Abstract
OBJECTIVE: The aim of the study is to explore the possibility of oral feeding in unresponsive wakefulness syndrome/vegetative state (UWS/VS) patients. METHOD: We reviewed the clinical information of 68 UWS/VS patients (mean age 45 ± 11; range 16-79 years) searching for mention of oral feeding. UWS/VS diagnosis was made after repeated behavioural assessments using the Coma Recovery Scale-Revised. Patients also had complementary neuroimaging evaluations (positron emission tomography, functional magnetic resonance imaging and electroencephalography and diffusion tensor imaging). RESULTS: Out of the 68 UWS/VS patients, only two could resume oral feeding (3%). The first patient had oral feeding (only liquid and semi liquid) in addition to gastrostomy feeding and the second one could achieve full oral feeding (liquid and mixed solid food). Clinical assessments concluded that they fulfilled the criteria for a diagnosis of UWS/VS. Results from neuroimaging and neurophysiology were typical for the first patient with regard to the diagnosis of UWS/VS but atypical for the second patient. CONCLUSION: Oral feeding that implies a full and complex oral phase could probably be considered as a sign of consciousness. However, we actually do not know which components are necessary to consider the swallowing conscious as compared to reflex. We also discussed the importance of swallowing assessment and management in all patients with altered state of consciousness.
OBJECTIVE: The aim of the study is to explore the possibility of oral feeding in unresponsive wakefulness syndrome/vegetative state (UWS/VS) patients. METHOD: We reviewed the clinical information of 68 UWS/VS patients (mean age 45 ± 11; range 16-79 years) searching for mention of oral feeding. UWS/VS diagnosis was made after repeated behavioural assessments using the Coma Recovery Scale-Revised. Patients also had complementary neuroimaging evaluations (positron emission tomography, functional magnetic resonance imaging and electroencephalography and diffusion tensor imaging). RESULTS: Out of the 68 UWS/VS patients, only two could resume oral feeding (3%). The first patient had oral feeding (only liquid and semi liquid) in addition to gastrostomy feeding and the second one could achieve full oral feeding (liquid and mixed solid food). Clinical assessments concluded that they fulfilled the criteria for a diagnosis of UWS/VS. Results from neuroimaging and neurophysiology were typical for the first patient with regard to the diagnosis of UWS/VS but atypical for the second patient. CONCLUSION: Oral feeding that implies a full and complex oral phase could probably be considered as a sign of consciousness. However, we actually do not know which components are necessary to consider the swallowing conscious as compared to reflex. We also discussed the importance of swallowing assessment and management in all patients with altered state of consciousness.
Authors: Susan L Brady; Meghan Darragh; Nelson G Escobar; Kara O'Neil; Theresa L B Pape; Noel Rao Journal: Brain Inj Date: 2006-12 Impact factor: 2.311
Authors: Daniel Kondziella; David K Menon; Raimund Helbok; Lionel Naccache; Marwan H Othman; Verena Rass; Benjamin Rohaut; Michael N Diringer; Robert D Stevens Journal: Neurocrit Care Date: 2021-07-08 Impact factor: 3.210