Incidence of Clinically Significant Responses to Zolpidem Among Patients with Disorders of Consciousness

Whyte, John; Myers, Robin R.

doi:10.1097/phm.0b013e3181a0e3a0

Cited by 141 publications

(102 citation statements)

References 10 publications

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“…[153][154][155][156][157][158][159][160] Whyte and Myers 157 conducted a placebo-controlled, double-blind, crossover trial in 15 patients who had been in VS or MCS for at least 1 month following traumatic or nontraumatic brain injury. Zolpidem (10 mg) or placebo was administered in blinded order on two different occasions, separated by 1-7 days.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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| The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

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Section: Pharmacological Interventionsmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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“…In terms of pharmacological interventions, aminergic and neurostimulant agents seem to be the most promising for patients with DOC. Zolpidem (a non-benzodiazepine sedative drug that is used for insomnia in healthy individuals) was shown to be effective to promote arousal and awareness, albeit in a small proportion of the patients [78]. The paradoxical effect of this sleeping pill was first shown in 2000 [79] and was since then verified and tested on larger patient groups [78][79][80].…”

Section: Challenges For Clinical Practicementioning

confidence: 99%

“…Zolpidem (a non-benzodiazepine sedative drug that is used for insomnia in healthy individuals) was shown to be effective to promote arousal and awareness, albeit in a small proportion of the patients [78]. The paradoxical effect of this sleeping pill was first shown in 2000 [79] and was since then verified and tested on larger patient groups [78][79][80]. The current hypothesis suggests that zolpidem acts by inducing a direct inhibition of the globus pallidus (an inhibitory structure of the brain), thus liberating the corticothalamic pathway leading to frontal cortices [81].…”

Section: Challenges For Clinical Practicementioning

confidence: 99%

Our Rapidly Changing Understanding of Acute and Chronic Disorders of Consciousness: Challenges For Neurologists

et al. 2012

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A number of recent studies suggest that some ‘vegetative state’ patients have been misdiagnosed, judging by their ability to follow commands and in some cases even communicate through brain activity. Such studies highlight the difficulty in forming a diagnosis based only on behavioral assessments. We think that neuroimaging and electrophysiology methods will be used more frequently in clinical settings, integrated with existing behavioral assessments. Such efforts are expected to lead to a more accurate understanding of individual patients’ cognitive abilities or even provide prognostic indicators. In terms of treatment planning (i.e., pain management and end-of-life decision-making), patients with disorders of consciousness are now offered the possibility of expressing their preferences by means of brain–computer interfaces. What remains to be clarified is the degree to which such indirect responses can be considered reliable and of legal representation.

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“…The authors found 1 responder of a total of 15 DOC patients. Behaviourally, the patient went from an UWS/VS to a MCS diagnosis according to the CRS-R assessments pre-and posttreatment [85]. Finally, Apomorphine is a non-selective d opaminergic agonist that was initially indicated to treat Parkinson's disease and erectile impotence but has also showed to have positive effects in a few cases of severely braininjured patients.…”

Section: Therapeutic Interventionsmentioning

confidence: 99%

Coma and related disorders

Charland‐Verville

Habbal

Laureys

et al. 2013

Swiss Arch Neurol Psychiatr

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SummaryDisorders of consciousness represent a major challenge in clinical practice. The last decade of neuroscience research brought new insights about brain function and neural correlates of these pathological states of consciousness. Although behavioural evaluation still remains the gold standard, conscious behaviours are too often missed, leading to unwanted grey zones between conscious and unconscious patients. In order to increase the chances of detecting the signs of consciousness, scientists now focus on the development and validation of neuroimaging and electrophysiological paradigms in noncommunicative patients. Recent insights in this field also raise new questions of medical ethics. Indeed, for conscious patients, legal questions will occur about treatment plans, rehabilitation and communication strategies while for the unconscious patients, end-of-life decisions will take place after the p atients' condition is stated as "permanent" or "irreversible". Coma and related disordersFor a long time, the primary seat of consciousness was believed to be localised only in the cerebral cortex [1]. It was only very recently that scientists were confronted with a great discovery. In 1949 neuroscientists found, through a nimal intracranial electrophysiological experiments, that the activation of the brain stem reticular formation was a ssociated with the level of arousal [2]. However, like other revolutionary discoveries, the idea was then abandoned some years later following many controversies. Fortunately, due to our recent advancements in consciousness research, these subcortical correlates of consciousness were brought back. In fact, we do not argue anymore that a preserved r eticular formation system is essential for normal vigilance, while the intralaminar nuclei of the thalami are implicated in higher order brain processes since the thalamus is the first centre for the integration and filtering of sensory inputs [3,4]. These subcortical structures are working closely together

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Incidence of Clinically Significant Responses to Zolpidem Among Patients with Disorders of Consciousness

Cited by 141 publications

References 10 publications

Disorders of consciousness after acquired brain injury: the state of the science

Disorders of consciousness after acquired brain injury: the state of the science

Our Rapidly Changing Understanding of Acute and Chronic Disorders of Consciousness: Challenges For Neurologists

Coma and related disorders

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