Zolpidem efficacy and safety in disorders of consciousness

Abstract

Sutton and Clauss presented a detailed review about the effectiveness of zolpidem, discussing recoveries from brain damage due to strokes, trauma and hypoxia. A significant finding has been the unexpected and paradoxical increment of brain activity in vegetative state/unresponsive wakefulness syndrome (VS/UWS). On the contrary, zolpidem is considered one of the best sleep inducers in normal subjects. We have studied series of VS/UWS cases after zolpidem intake. We have demonstrated EEG activation, increment of BOLD signal in different brain regions, and an autonomic influence, mainly characterized by a vagolytic chronotropic effect without a significant increment of the vasomotor sympathetic tone. As this autonomic imbalance might induce cardio- circulatory complications, which we didn't find in any of our patients, we suggest developing future trials under control of physiological indices by bedside monitoring. However, considering that the paradoxical arousing zolpidem effect might be certainly related to brain function improvement, we agree with Sutton and Clauss that future multicentre and multinational clinical trials should be developed, but under control of physiological indices.

Modified Suanzaoren decoction in treating post-stroke cognitive impairment with comorbid insomnia symptoms: A clinical trial

“…The sedative and hypnotic effects of Suanzaoren decoction are mainly mediated by the GABAergic and serotonergic systems. [51] Zolpidem, a widely used non-benzodiazepine sleeping aid, [23,52] with a long marketing history and favorable safety profile, [53] is particularly suitable for elderly patients with chronic insomnia. [54] As for cognitive function of stroke patients, both groups had significant improvement compared with baseline, and the comparison between the groups showed that M-SZRD group had better curative effect.…”

“…The sedative and hypnotic effects of Suanzaoren decoction are mainly mediated by the GABAergic and serotonergic systems. [ 51 ] Zolpidem, a widely used non-benzodiazepine sleeping aid, [ 23 , 52 ] with a long marketing history and favorable safety profile, [ 53 ] is particularly suitable for elderly patients with chronic insomnia. [ 54 ]…”

Continuous autonomic nervous system assessment using heart rate variability methodology during near-death and mystical experiences

“…Due to the intricate involvement of our heart with our emotions (not just metaphorically), this variation reflects our physiological state and the level of emotional arousal we are experiencing. [48][49][50][51][52][53][54][55] The emerging technology of CEEG in intensive care units gives practitioners the ability to identify changes in the ANS by recording an electrocardiogram (ECG) leads and calculating heart rate (HR) and heart rate variability (HRV).…”

Is the awakening produced by benzodiazepines due to excitatory actions of GABA?

“…Awakening, a temporary revival of patients who have been akinetic, apathic and with no reaction for years following a large brain damage, has been observed after administration of drugs even if the mechanisms underlying them remain unknown. Although rare, the awakenings produced briefly by "sleeping pills" are now well documented [1][2][3]. Arnst et al recently reported spectacular effects of Benzodiazepines (BZDs) on a 29 years old patient after a severe hypoxic-ischemic brain injury and following a history of alcohol abuse [4].…”

“…Electroencephalogram (EEG) and magnetoencephalogram source-spectral analysis indicate a small but significant increase of beta and gamma band after Zolpidem treatment. It is usually considered that Zolpidem restores globally the excitation/inhibition imbalance due to a reduced GABAergic inhibitory drive [1][2][3][4][5]. Williams and colleagues reported an abrupt reduction of 6-10 Hz oscillations and the coherence between the two hemispheres in 3 patients with known positive response to Zolpidem [2].…”