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American Journal of the Medical Sciences:
doi: 10.1097/MAJ.0b013e318287c79c
Clinical Investigation

Zolpidem Arouses Patients in Vegetative State After Brain Injury: Quantitative Evaluation and Indications

Du, Bo MS; Shan, Aijun MS; Zhang, Yujuan MS; Zhong, Xianliang MS; Chen, Dong MS; Cai, Kunhao MS

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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 99mTc-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.

Copyright © 2013 by the Southern Society for Clinical Investigation

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