Transient awakening from vegetative state: Is high‐dose zolpidem more effective?

Calabrò, Rocco Salvatore; Aricò, Irene; Salvo, Simona De; Conti-Nibali, Valeria; Bramantı, Placido

doi:10.1111/pcn.12215

Cited by 21 publications

(13 citation statements)

References 4 publications

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“…In a last casereport, recovery of consciousness was observed in a patient in UWS (> 3 years post-cardiac arrest) when using higher dosage of zolpidem (30 mg instead of 10 mg). 24 The patient started to demonstrate signs of consciousness when receiving 20 mg and further improved after 30 mg of zolpidem, suggesting that higher dosage may induce stronger effects.…”

Section: Zolpidemmentioning

confidence: 94%

Therapeutic interventions in patients with prolonged disorders of consciousness

Thibaut

Schiff

Giacino

et al. 2019

The Lancet Neurology

265

229

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The management of patients with severe brain injuries and prolonged disorders of consciousness (DOC) raises important issues particularly with respect to their therapeutic options. The lack of treatment is challenged by new clinical and neuroimaging data indicating that some patients with prolonged DOC may benefit from therapeutic interventions, even years after the injury. The majority of the studies aiming at improving patients' level of consciousness and functional recovery includes behavioural and brain imaging open-label trials and case-reports, but several randomized clinical trials (RCT) have been conducted, especially using non-invasive brain stimulation. Only a couple of RCTs focused on the effects of drugs or sensory stimulation approaches, and only two Class II studies, on amantadine and transcranial direct current stimulation, have been published. While new therapeutic approaches seem to be valuable for patients with prolonged DOC, optimized stimulation parameters, alternative drugs or rehabilitation strategies still need to be tested and validated.

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Section: Zolpidemmentioning

confidence: 94%

Therapeutic interventions in patients with prolonged disorders of consciousness

Thibaut

Schiff

Giacino

et al. 2019

The Lancet Neurology

265

229

View full text Add to dashboard Cite

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“…However, one study conducted by Hall and colleagues used MEG (along with fMRI, MRS, and SPECT) (functional magnetic resonance imaging, magnetic resonance spectroscopy, and singlephoton emission computed tomography) to observe coincidental sensorimotor and cognitive improvements in a stroke patient [18]. e authors reported reduced MEG signal power in the theta (4-10 Hz) and beta (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) bands after zolpidem uptake. Subsequently, Williams and colleagues investigated the resting state brain using EEG in order to identify a possible mechanism underlying zolpidem response after brain injury and reported reduced EEG power and coherence at low frequencies (6-10 Hz) [19].…”

Section: Introductionmentioning

confidence: 99%

“…Subsequently, Williams and colleagues investigated the resting state brain using EEG in order to identify a possible mechanism underlying zolpidem response after brain injury and reported reduced EEG power and coherence at low frequencies (6-10 Hz) [19]. A number of other studies using EEG reported incomplete or inconclusive results [20][21][22]. In a structured study, Whyte and Myers investigated 84 participants with disorders of consciousness and reported that 4.8% of the participants were responsive to zolpidem [23].…”

Section: Introductionmentioning

confidence: 99%

Effect of Zolpidem in the Aftermath of Traumatic Brain Injury: An MEG Study

Sripad

Rosenberg

Boers

et al. 2020

Case Reports in Neurological Medicine

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In the past two decades, many studies have shown the paradoxical efficacy of zolpidem, a hypnotic used to induce sleep, in transiently alleviating various disorders of consciousness such as traumatic brain injury (TBI), dystonia, and Parkinson’s disease. The mechanism of action of this effect of zolpidem is of great research interest. In this case study, we use magnetoencephalography (MEG) to investigate a fully conscious, ex-coma patient who suffered from neurological difficulties for a few years due to traumatic brain injury. For a few years after injury, the patient was under medication with zolpidem that drastically improved his symptoms. MEG recordings taken before and after zolpidem showed a reduction in power in the theta-alpha (4–12 Hz) and lower beta (15–20 Hz) frequency bands. An increase in power after zolpidem intake was found in the higher beta/lower gamma (20–43 Hz) frequency band. Source level functional connectivity measured using weighted-phase lag index showed changes after zolpidem intake. Stronger connectivity between left frontal and temporal brain regions was observed. We report that zolpidem induces a change in MEG resting power and functional connectivity in the patient. MEG is an informative and sensitive tool to detect changes in brain activity for TBI.

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“…11.3b). Another recent chronic post-anoxic UWS case report showed an increase of amplitude and voltage with a theta-beta rhythm over temporal areas along with an increase of CRS-R score during higher dosage of zolpidem (30 mg instead of 10 mg) without relevant side effects [70]. A mechanism of cell dormancy was proposed to explain the effect of zolpidem: certain nonspecific areas of the brain, adjacent or distant to the initially damaged zones (e.g., the ipsilateral and contralateral hemisphere or the cerebellum), might be inhibited by the lesion.…”

Section: Zolpidemmentioning

confidence: 92%

Pharmacological Treatments

2013

Handbook for Attention Deficit Hyperactivity Disorder in Adults

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We review the current state of knowledge of potentially useful drugs acting on the recovery of consciousness in severely brain-damaged patients. Exploratory and retrospective studies as well as case reports on the sporadic cases of recovery are discussed regarding pharmacological treatments such as amantadine, levodopa, bromocriptine, apomorphine, methylphenidate, zolpidem, baclofen, and lamotrigine. Potential underlying mechanisms explaining the effects of these drugs on the awakening and recovery of consciousness in this challenging population are also examined. Finally, we discuss the process of using single-subject methods to assess the off-label use of a specific medication.

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Transient awakening from vegetative state: Is high‐dose zolpidem more effective?

Cited by 21 publications

References 4 publications

Therapeutic interventions in patients with prolonged disorders of consciousness

Therapeutic interventions in patients with prolonged disorders of consciousness

Effect of Zolpidem in the Aftermath of Traumatic Brain Injury: An MEG Study

Pharmacological Treatments

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