A case of post-traumatic minimally conscious state reversed by midazolam: Clinical aspects and neurophysiological correlates

Abstract

Purpose: We describe the case of a subject in a post-traumatic Minimally Conscious State (MCS) who retrieved full interaction with the environment after midazolam infusion. We studied EEG correlates of the "awakening reaction" in the different domains of frequency, time and cortical topography, along with the intrinsic connectivity within both the task-positive and the linguistic network. Methods: EEG recorded before and after midazolam administration has been submitted to spectral power analysis, sLORETA analysis and intrinsic connectivity analysis within both functional networks. Results: A critical change in the power spectrum profile was observed after midazolam: a) the power between 1 and 12 Hz decreased, reaching its maximum difference with respect to pre-infusion at about 7 Hz and b) the power between 12 and 30 Hz increased, with a maximum difference at about 15 Hz. At the same time, midazolam induced significant connectivity changes, especially for these two frequency bands, within both functional networks. Conclusions: We advance some hypotheses about certain aspects of the recovery from the MCS both in terms of anatomofunctional correlations and functional brain systems and we make inferences about the role that some kind of 'catatonic' symptoms might play in determining and/or maintaining this peculiar clinical state.

Therapeutic interventions in patients with prolonged disorders of consciousness

“…Intrathecal baclofen is primarily used as a centrally acting treatment for spasticity but it has been suggested as a potential drug to stimulate the recovery of consciousness in a few uncontrolled studies and case-reports. 15,28 The effects of midazolam (benzodiazepine receptor agonist) 18 and ziconitide (atypical analgesic, selective blocker of N-type calcium channels) 19 have also been reported in two single-case studies as stimulant for the recovery of consciousness of patients with prolonged DOC (one MCS and one UWS, respectively). 18,19 These anecdotal findings need to be confirmed with controlled studies.…”

“…Amantadine (dopamine agonist and NMDA antagonist [11][12][13][14], intrathecal baclofen (GABA agonist 15 ), zolpidem (nonbenzodiazepine GABA agonist 16,17 ), midazolam (benzodiazepine GABA agonist 18 ) and ziconotine (calcium channel blocker 19 ) have been employed to improve the level of consciousness and functional recovery in patients with DOC.…”

Case Report: Use of Subcutaneous Midazolam During an Episode of Catatonia

“…Such symptoms often prevent the patient from accepting any form of oral treatment, and encourage clinicians to find alternative routes for BZD administration. Only a few case reports have previously described that intravenous (IV) administration of Midazolam could help diagnose catatonia (5) or alleviate its symptoms (6)(7)(8)(9). But as far as we know, the successful use of subcutaneous (SC) Midazolam as a treatment for catatonia has never been reported.…”

A Review of Resting-State Electroencephalography Analysis in Disorders of Consciousness

“…Spectrum power, connectivity of coherence, and phase synchronization have been used to assess the cerebral changes of patients in pharmacological treatment ( 53 , 55 ). For MCS patients who respond to midazolam, spectrum power changes and connectivity changes were found after taking the medication ( 55 ). While under zolpidem treatment, all patients showed a distinct low-frequency oscillatory peak at approximately 6–10 Hz over the fronto-central regions ( 53 ).…”