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Zolpidem and Restoration of Consciousness

Whyte, John MD, PhD; Rajan, Riya BA; Rosenbaum, Amy PhD; Katz, Douglas MD; Kalmar, Kathleen PhD; Seel, Ron PhD; Greenwald, Brian MD; Zafonte, Ross DO; Demarest, David PhD; Brunner, Robert MD; Kaelin, Darryl MD

American Journal of Physical Medicine & Rehabilitation: February 2014 - Volume 93 - Issue 2 - p 101–113
doi: 10.1097/PHM.0000000000000069
Original Research Articles

Objective Zolpidem has been reported to cause temporary recovery of consciousness in vegetative and minimally conscious patients, but how often and why this occurs are unknown. The authors aimed to determine the frequency of this phenomenon and whether it can be predicted from demographic and clinical variables.

Design This is a placebo-controlled, double-blind, single-dose, crossover study performed by caregivers and replicated by trained professionals, for naive participants. Four previously identified responders were also studied to further characterize the clinical drug response.

Results Eighty-four participants with traumatic and nontraumatic disorders of consciousness of at least 4 mos’ duration were studied. Four “definite responders” were identified, but no demographic or clinical features were predictive of the response. Indicators of a drug response included increased movement, social interaction, command following, attempts at communication, and functional object use; typically lasted 1–2 hrs; and sometimes ended with increased somnolence. Adverse events were more common on zolpidem than placebo, but most were rated as mild.

Conclusions Approximately 5% (4.8%) of the participants responded to zolpidem, but the responders could not be distinguished in advance from the nonresponders. Future research is needed to understand the mechanism of zolpidem in enhancing consciousness and its potential role in treatment and research.

From the Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (JW, RR); Park Terrace Care Center, Rego Park Queens, New York (AR); Department of Neurology, Boston University School of Medicine, Massachusetts (DK); Brain Injury Program, Braintree Rehabilitation Hospital, Massachusetts (DK); JFK Johnson Rehabilitation Institute Center for Head Injuries, Edison, New Jersey (KK); Crawford Research Institute and Brain Injury Program, Shepherd Center, Atlanta, Georgia (RS); Department of Rehabilitation Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York (BG); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts (RZ); On With Life, Ankeny, Iowa (DD); Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham (RB); and Division of Physical Medicine and Rehabilitation, University of Louisville, Kentucky (DK).

All correspondence and requests for reprints should be addressed to John Whyte, MD, PhD, Moss Rehabilitation Research Institute, 50 Township Line Rd, Elkins Park, PA 19027.

Supported, in part, by grant no. H133G080066 from the National Institute on Disability and Rehabilitation Research (NIDRR), United States Department of Education (J.W., principal investigator).

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.