Zolpidem arouses patients in vegetative state after brain injury: quantitative evaluation and indications.

Abstract

BACKGROUND:

To investigate the efficacy and indications of zolpidem, a nonbenzodiazepine hypnotic, inducing arousal in vegetative state patients after brain injury.

METHODS:

One hundred sixty-five patients were divided into 4 groups, according to area of brain damage and injury mechanism. All patients' brains were imaged by Tc-ECD single-photon emission computerized tomography (SPECT), before and 1 hour after treatment with 10 mg of zolpidem. Simultaneously, 3 quantitative indicators of brain function and damage were obtained using cerebral state monitor. Thirty-eight patients withdrew from the study after the first zolpidem dose. The remaining 127 patients received a daily dose of 10 mg of zolpidem for 1 week and were monitored again at the end of this week.

RESULTS:

One hour after treatment with zolpidem, cerebral state index was increased and burst suppression reduced in both brain contrecoup contusion and space-occupying brain compression groups (P < 0.05). SPECT showed, 1 hour after medication, that cerebral perfusion was improved in both brain contrecoup contusion and space-occupying brain compression groups, but no changes were seen in primary and secondary brain stem injury groups. In the 127 patients' group, after 1 week of zolpidem treatment, all parameters obtained from cerebral state monitor were not statistically different compared with those after the initial medication (P > 0.05).

CONCLUSIONS:

Zolpidem is an effective medicine to restore brain function in patients in vegetative state after brain injury, especially for those whose brain injuries are mainly in non-brain-stem areas. Improvement of brain function is sudden rather than gradual.

• Authors: Bo Du, Aijun Shan, Yujuan Zhang, Xianliang Zhong, Dong Chen, Kunhao Cai
• Journal: The American journal of the medical sciences (Am J Med Sci) Vol. 347 Issue 3 Pg. 178-82 (Mar 2014) ISSN: 1538-2990 [Electronic] United States
• PMID: 23462249 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Hypnotics and Sedatives
• Organotechnetium Compounds
• Pyridines
• Zolpidem
• technetium Tc 99m bicisate
• Cysteine

Topics

• Adult
• Brain (blood supply)
• Brain Injuries (diagnostic imaging, drug therapy, physiopathology)
• Cerebrovascular Circulation (drug effects)
• Cysteine (analogs & derivatives)
• Female
• Humans
• Hypnotics and Sedatives (therapeutic use)
• Male
• Middle Aged
• Organotechnetium Compounds
• Persistent Vegetative State (diagnostic imaging, drug therapy, physiopathology)
• Pyridines (therapeutic use)
• Tomography, Emission-Computed, Single-Photon
• Zolpidem