Zolpidem in a minimally conscious state

Singh, Rajiv; McDonald, Clare; Dawson, Kirstin; Lewis, Shôn; Pringle, Anne-Marie; Smith, Stephen J.; Pentland, Brian T.

doi:10.1080/02699050701829704

Cited by 49 publications

(34 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[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

View full text Add to dashboard Cite

| 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.

show abstract

Section: Pharmacological Interventionsmentioning

confidence: 99%

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

et al. 2014

View full text Add to dashboard Cite

show abstract

“…However, in an assessorblinded, single case study of a man in MCS 4 years following TBI, zolpidem did not improve ability to follow instructions, and in fact, resulted in slight worsening in performance at some tasks. Assessments in this study were performed daily for 1 week while on zolpidem and for another week off zolpidem [45]. Clearly, more controlled studies are required to determine the role of zolpidem in disorders of consciousness following TBI.…”

Section: Zolpidemmentioning

confidence: 99%

Pharmacological management of neurobehavioral disorders following traumatic brain injuryA state-of the-art review

Chew

Zafonte²

2009

JRRD

159

103

View full text Add to dashboard Cite

Abstract-Pharmacological management of neurobehavioral disorders following traumatic brain injury (TBI) is common practice. However, the evidence available to guide this practice remains sparse. This review summarizes, in brief, the state of knowledge, organized via a time continuum from injury as well as by symptom complex. The areas of neuroprotection, hypoarousal, attention and memory deficits, aggression, agitation, depression, and mania are reviewed. The literature was searched with PubMed on the terms "traumatic brain injury" or "brain injury" with "pharmacology" (and the symptoms according to which this review is arranged). Additional searches were conducted with the specific symptoms as search terms, crossed with the therapeutic agents or drug classes discussed. Where a paucity of prospective data exists, case reports and retrospective studies are included. Studies to date have yielded minimal positive evidence for enhancing function, memory, and behavior after TBI. No single agent likely will become sentinel in the recovery process, and combination therapy in the acute and postacute settings are required. A need exists to further define the role of psychopharmacology in postacute TBI medicine and the specific characteristics of subpopulations who might benefit.

show abstract

“…Another hypothesis claims that zolpidem may activate limbic loops modulating motivational processes thus leading to disinhibition and thalamocortical overactivity [5]. Paradoxical restoration of consciousness by CNS depressants is thought to be by functional restoration of certain networks like reticular activating system, cortico -cortical loop and cortico -thalamo-cortical loop as suggested by functional neuroimaging studies [3,6,7]. However, not all patients with disorders of consciousness respond to zolpidem as noted in a placebo controlled trial [2].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

AAD

View full text Add to dashboard Cite

Creutzfeldt -Jacob disease is a rare form of dementia associated with neuropathological finding of accumulation of prion proteins in the brain with rapid deterioration and disability [1]. Alteration in the level of consciousness has been studied in dementia and other hypoxic brain injuries. Attempt to modulate the effect of pharmacological agents and deep brain stimulation to attain the maximum level of consciousness is ongoing but the evidence is lacking [2]. This report supports the use of zolpidem in the arousal from altered consciousness in a patient with sporadic CJD. Case ReportA 59 year old woman presented with 7 months history of gradual onset visual disturbances which progressed to near complete visual loss (diagnosed as cortical blindness). She also developed behavioural changes characterized by reduced spontaneity, decreased social interaction, and progressive reduction in speech output, along with worsening memory for recent events and gait ataxia. Two weeks prior to admission, she became progressively mute with poor comprehension, and also developed double incontinence, generalised myoclonic jerks, was bed -bound and was unable to take foods orally. There was no history of seizures and no past history of tissue or organ transplantation or eating bovine brain. There was no family history of dementia or neurological illnesses except Parkinsonism in patient's elder brother.On examination she was awake and was opening eyes spontaneously with no verbal output. She was not obeying simple commands but would localize pain. She had severe rigidity of all limbs (lower limbs slightly more than upper limbs), intermittent myoclonic jerks which were not stimulus sensitive, and brisk deep tendon reflexes with bilaterally extensor plantar reflex. Grasp reflexes were present bilaterally.Investigations including CBC, metabolic panel, thyroid profile and serum B12 levels were normal. TPO antibody, autoimmune encephalitis workup for antibodies against NMDA, AMPA 1 and 2, VGKC (LGI-1 and CASPR), GABA 1 and 2, and autoimmune panel for vasculitis were negative. MRI Brain (Figure 1) showed cortical ribbon sign with bilateral involvement of caudate and putamen, which was highly suggestive of prion disease like CJD. EEG showed frequent bilateral periodic triphasic discharges with diffuse slowing of background activity. Patient met diagnostic criteria for probable CJD by World Health Organization (Figure 2).Patient had not responded earlier to trials of L-dopa, donepezil, memantine, amantadine and a course of methyl prednisolone. Care givers reported earlier noticing a marked improvement in her responsiveness when she was given tablet zolpidem for insomnia for two nights. Based on this history, a trial of immediate release tablet zolpidem 5 mg HS was started. Response was noticed 7 hours after the first dose in the form of patient spontaneously getting up from the bed, attempting to walk with assistance and taking food orally by self-removal of nasogastric tube. She also started initiating verbal communication with care give...

show abstract

Zolpidem in a minimally conscious state

Cited by 49 publications

References 13 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

Pharmacological management of neurobehavioral disorders following traumatic brain injuryA state-of the-art review

Untitled

Contact Info

Product

Resources

About