Efficacy of zolpidem for dystonia: a study among different subtypes

Abstract

Although there are some newly developed options to treat dystonia, its medical treatment is not always satisfactory. Zolpidem, an imidazopyridine agonist with a high affinity on benzodiazepine subtype receptor BZ1 (ω1), was found to improve clinical symptoms of dystonia in a limited number of case reports. To investigate what subtype of dystonia is responsive to the therapy, we conducted an open label study to assess the efficacy of zolpidem (5–20 mg) in 34 patients suffering from miscellaneous types of dystonia using the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Patients were entered into the study if they had been refractory to other medications as evaluated by BFMDRS (no change in the previous two successive visits). After zolpidem therapy, the scores in the patients as a whole were decreased from 7.2 ± 7.9 to 5.5 ± 5.0 (P = 0.042). Patients with generalized dystonia, Meige syndrome/blepharospasm, and hand dystonia improved in the scale by 27.8, 17.8, and 31.0%, respectively, whereas no improvement was found in cervical dystonia patients. Overall response rate among patients were comparable to that of trihexyphenidyl. Zolpidem may be a therapeutic option for generalized dystonia, Meige syndrome, and hand dystonia including musician’s. Drowsiness was the dose-limiting factor.

Response to zolpidem in oromandibular dystonia: A case report

“…c o m / l o c a t e / p a r k r e l d i s movement disorders is growing. Reports of patients with different types of dystonia, such as blepharospasm, Meige syndrome, focal hand or neck dystonia, generalized dystonia, and tardive dystonia, have described improvement with oral dosages ranging between 10 and 70 mg daily, as summarized in Table 1 [2,3]. An earlier report described a similar patient with jaw-opening oromandibular dystonia who required a combination of botulinum toxin injections, zolpidem, and relaxation procedures to improve his symptoms [4].…”

Treatment of Dystonia

“…Sodium oxybate was demonstrated to be efficacious in a pilot study for the treatment of alcohol-responsive disorders, such as myoclonus-dystonia [26]. In an open-label study involving 34 patients with dystonia, zolpidem, an agent with affinity for a benzodiazepine receptor, was found to be effective for generalized dystonia, cranial dystonia, blepharospasm, and hand dystonia, but not cervical dystonia [16]. Pregabalin was reported to be effective in a case of secondary dystonia after subarachnoid and intracerebral hemorrhage.…”

“…Adverse effects are dose-related and reversible upon lowering the medication. Parkinsonism can be treated with amantadine, dopamine agonists, or levodopa; depression with antidepressants; and insomnia and akathisia with zolpidem [15], which may also help dystonia [16]. Such a strategy may allow the patient to continue the tetrabenazine treatment, particularly if it benefits the underlying dystonia.…”

Zolpidem withdrawal status dystonicus in the patient with advanced Parkinson's disease

“…Zolpidem, a commonly prescribed medication to treat insomnia [1], has been reported to improve symptoms in movement disorders, particularly primary and secondary dystonia, and Parkinson's disease (PD) [2,3]. We report a patient with idiopathic PD and associated (secondary) dystonia who developed dystonic status after abrupt zolpidem withdrawal.…”

“…These receptors are highly represented in the basal ganglia (the ventral globus pallidus and the substantia nigra pars reticulata), possibly explaining zolpidem role in improving parkinsonism and dystonia [2,3]. For treating insomnia, zolpidem is a popular alternative to benzodiazepines due to its efficacy and a better safety profile, with adverse effects such as withdrawal seizures or delirium occurring only rarely [1].…”