Is oral feeding compatible with an unresponsive wakefulness syndrome?

INTRODUCTION AND AIMS
Vegetative state/Unresponsive wakefulness syndrome (VS/UWS) is defined by
the presence of eye-opening and the absence of awareness and voluntary
movement (Laureys et al., 2010). VS/UWS patients classically receive hydration
and nutrition through an enteral feeding tube. We present the cases of two
patients that were diagnosed as VS/UWS but were able to resume oral feeding. It
is however unclear if the presence of oral feeding is compatible with the
diagnosis of VS/UWS or if this observation should lead to a modification of the
diagnosis.
METHODS AND RESULTS
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,
(Teasdale & Jennet, 1974)) in association with complementary evaluations using
neuroimaging techniques. Of the 65 VS/UWS patients, two could resume oral
feeding (3%). One could achieve full oral feeding (mixed texture and liquid) and
the other had oral feeding (liquid and semi-liquid) 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 (fronto-
parietal associative areas, posterior parietal areas, cingulate cortices, precuneus)
and preserved metabolism in the brainstem and cerebellum (using positron
emission tomography).
CONCLUSIONS
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
systematic swallowing evaluation in patients with altered state of consciousness
regardless of their level of consciousness. Moreover, 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.