Is oral feeding compatible with an unresponsive wakefulness syndrome?

Introduction : Vegetative state/unresponsive wakefulness syndrome (VS/UWS) is defined by
the presence of eye-opening and the absence of awareness and voluntary movement [1]. VS/UWS
patients classically receive hydration and nutrition through an enteral feeding tube. Objective -
Methods : We retrospectively reviewed the clinical information of 65 VS/UWS patients (aged
45±12; range 16-85 years) evaluated at the CHU hospital of liege searching for mention of oral
feeding. VS/UWS diagnosis was made after repeated behavioral assessments using the
standardized coma recovery scale–revised (CRS-R, [2]) in association with complementary
evaluations using neuroimaging techniques. Results : Of the 65 VS/UWS patients, two could
resume oral feeding (3%). One could achieve full oral feeding and the other had oral feeding in
addition to gastrostomy feeding. Neuroimaging evaluations showed in both patients a massive
decrease in the spontaneous brain activity and its functional connectivity (using functional
magnetic resonance imaging), bilateral cerebral cortex hypometabolism and preserved metabolism
in the brainstem and cerebellum (using positron emission tomography). Discussion – Conclusion
– Clinical message : oral feeding is rare in VS/UWS patients (3% in our cohort). Based on
neuroimaging results, this behaviour does not seem to be incompatible with the diagnosis of
VS/UWS but the neuromecanistic root, which allows this behavior, still needs to be elucidate.
This study also emphasizes the importance of assess and manage deglutition in patients with
altered state of consciousness regardless of their level of consciousness. Tactile oro-facial
stimulation, manual therapy, taste stimulation and therapeutic feeding can be another “gateway”
to interact with these patients and improve their quality of life.