Cerebellar Mutism Treated Successfully With Zolpidem in a Patient With Learning Difficulties

Abstract

Posterior fossa tumors constitute the most common brain tumor in pediatrics with 25% development postresection. Cerebellar mutism can manifest as neurobehavioral abnormalities that can occur within days to months after surgery but usually peak on the third postoperative day. It can be caused by discontinuation of dento-thalamo-cortical pathway in the vermian lesion, due to edema, tumors, and hypoperfusion. We report a seven-year-old patient with posterior fossa lesion (pilocytic astrocytoma in histopathology) and learning difficulties with symptoms of urinary retention, pseudobulbar palsy, and motor incoordination that were treated successfully with zolpidem 2.5 mg with regain of function by the third month.

The outcome of using zolpidem for treatment of postoperative posterior fossa syndrome in children with brain tumor

“…The use of zolpidem in children with PFS in our patient population coincided with clinical improvements similar to the described cases in other neurological and psychiatric diseases. [23][24][25][26] The proposed mechanism of zolpidem in PFS has a paradoxical effect on the corticostriatopallidal thalamocortical pathway in patients affected by PFS and reverses the effect of intraoperative damage to this area. [32,42] Nevertheless, the effective doses, timing of administration, and effects of concurrent use of steroids on the course of PFS were not investigated.…”

“…[9,[11][12][13] Other risk factors are found to be either uncertain or unlikely for the development of cerebellar mutism syndrome. [14][15][16][17][18][19][20][21][22] A few published case reports have described the effect of multiple drugs used to treat different PFS symptoms such as bromocriptine [23,24] reverse akinetic mutism; nimodipine [25] to prevent ischemia due to vasospasms; carbamazepine [26] used as mood stabilizers; melatonin [27] used for neuroprotection; steroids utmost given pre-, intra-, and postoperatively to reduce edema and inflammation, [28] although their role is indeterminate in treating and preventing PFS; fluoxetine used to reverse akinetic mutism [29] ; risperidone [30] for agitation and behavioral control; and a couple of cases that used zolpidem (majority reported from karatchi) showing that the use of zolpidem in children with PFS alleviates mutism, increases speech, and decreases emotional lability. [31,32] Zolpidem is an oral drug, a nonbenzodiazepine sedative hypnotic of the pyrazolopyrimidine class that is structurally unrelated to benzodiazepines but interacts with a GABA benzodiazepine receptor complex and shares some of the pharmacologic properties of benzodiazepines.…”

“…A few published case reports have described the effect of multiple drugs used to treat different PFS symptoms such as bromocriptine [23,24] reverse akinetic mutism; nimodipine [25] to prevent ischemia due to vasospasms; carbamazepine [26] used as mood stabilizers; melatonin [27] used for neuroprotection; steroids utmost given pre-, intra-, and postoperatively to reduce edema and inflammation, [28] although their role is indeterminate in treating and preventing PFS; fluoxetine used to reverse akinetic mutism [29] ; risperidone [30] for agitation and behavioral control; and a couple of cases that used zolpidem (majority reported from karatchi) showing that the use of zolpidem in children with PFS alleviates mutism, increases speech, and decreases emotional lability. [31,32]…”