Treatment of apathy with Zolpidem (Stilnox®): Two double-blind, placebo-controlled single case studies

Mathieu, S.; Autret, K.; Arnould, Annabelle; Travers, C.; Charveriat, Sophie; Vandenhelsken, C.; Jegousse, G.; Genêt, F.; Azouvi, Philippe

doi:10.1016/j.rehab.2011.07.389

Cited by 3 publications

(4 citation statements)

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“…Causes of DOCs included anoxic brain injury (n = 13), traumatic brain injury (TBI) (n = 14), and stroke (n = 9), most commonly affecting the brainstem. The remaining studies (n = 14) fell under other broad classifications or were case series with a combination of patients with various disorders. These disorders included stroke (n = 6), encephalopathy (n = 3), DOCs (n = 3), spinocerebellar ataxia (n = 2), TBI (n = 2), dementia (n = 1), cerebellar ataxia (n = 1), cerebellar mutism (n = 1), and autism (n = 1)…”

Section: Resultsmentioning

confidence: 99%

“…For example, there have been documented improvements in verbal communication in cerebellar mutism, akinetic mutism due to encephalopathy, catatonia, and poststroke aphasia . Two studies also reported improvements in apathy secondary to anoxic encephalopathy and stroke . One case report observed improved cognitive function in a woman with dementia due to corticobasal atrophy.…”

Section: Resultsmentioning

confidence: 99%

“…46,[51][52][53] Causes of DOCs included anoxic brain injury (n = 13), [37][38][39][40]43,45,48,[51][52][53][54][55][56] traumatic brain injury (TBI) (n = 14), 2,39,41,42,44,45,47,[49][50][51][52][53]56 and stroke (n = 9), 41,42,44,45,47,[51][52][53][54] most commonly affecting the brainstem. The remaining studies (n = 14) [57][58][59][60][61][62][63][64][65][66][67][68]…”

Section: Neurologic Disordersmentioning

confidence: 99%

“…The remaining studies (n = 14) [57][58][59][60][61][62][63][64][65][66][67][68][69][70] fell under other broad classifications or were case series with a combination of patients with various disorders. These disorders included stroke (n = 6), 57,60,62,63,67,69 encephalopathy (n = 3), 58,64,66 DOCs (n = 3), 60,61,67 spinocerebellar ataxia (n = 2), 59,60 TBI (n = 2), 68,69 dementia (n = 1), 65 cerebellar ataxia (n = 1), 61 cerebellar mutism (n = 1), 70 and autism (n = 1). 61…”

Section: Neurologic Disordersmentioning

confidence: 99%

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Zolpidem for the Treatment of Neurologic Disorders

et al. 2017

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IMPORTANCE Given its selective action on the ω1 subtype of the γ-aminobutyric acid A receptor, zolpidem tartrate presents a potential treatment mechanism for other neurologic disorders.OBJECTIVE To synthesize studies that used zolpidem to treat neurologic disorders.EVIDENCE REVIEW Eligibility criteria included any published English-language article that examined the use of zolpidem for noninsomnia neurologic disorders in humans for all dates up to March 20, 2015. Searched databases included PubMed, Scopus, Web of Science Core Collection, the Cochrane Library, EMBASE, CENTRAL, and clinicaltrials.gov. Publication bias was mitigated by searching clinicaltrials.gov for unpublished studies. Two rounds of screening were performed based on title and then abstract, and coding was performed by 2 coders. All methods followed the PRISMA Reporting Guidelines for systematic reviews of the literature.FINDINGS The initial search produced 2314 articles after removing duplicates. After exclusion based on a review of abstracts, 67 articles remained for full manuscript review. Thirty-one studies treated movement disorders, 22 treated disorders of consciousness, and 14 treated other neurologic conditions, including stroke, traumatic brain injury, encephalopathy, and dementia. Study designs included case reports (n = 28), case series (n = 8), single-patient interventional (n = 13), pretest and posttest (n = 9), randomized clinical trials (n = 9), and crossover studies (n = 5). Only 11 studies had more than 10 participants. Effects of zolpidem were wide ranging (eg, improvement on the JFK Coma Recovery Scale-Revised, the Unified Parkinson Disease Rating Scale, and the Burke-Fahn-Marsden Dystonia Rating Scale) and generally lasted 1 to 4 hours before the participant returned to baseline. Sedation was the most common adverse effect.CONCLUSIONS AND RELEVANCE Zolpidem has been observed to transiently treat a large variety of neurologic disorders, most often related to movement disorders and disorders of consciousness. Much of what is known comes from case reports and small interventional trials. These findings may represent a new treatment mechanism for these disorders.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Neurologic Disordersmentioning

confidence: 99%

Section: Neurologic Disordersmentioning

confidence: 99%

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Zolpidem for the Treatment of Neurologic Disorders

et al. 2017

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A review of the evidence of zolpidem efficacy in neurological disability after brain damage due to stroke, trauma and hypoxia: A justification of further clinical trials

Sutton¹,

Clauss

2017

Brain Injury

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During 15 years, 23 clinical reports and 6 studies have demonstrated associations between sub-sedative doses of zolpidem and recoveries from brain damage due to strokes, trauma and hypoxia. Clinical findings include unexpected awakenings from vegetative states and regressions of stroke symptoms after dosing that disappear during elimination and reappear on repeat dosing. Initially single-photon emission computed tomography scans showed improved perfusion within, around and distant from infarctions. Then positron emission tomography scans and electroencephalography detected renewed metabolic and neuronal activity. Placebo or a similar, gamma-aminobutyric acid (GABA)-ergic, sedative zopiclone has no such effect. The effect appears only several months after the injury, reflecting recent evidence in mice of substantial differences between the states of GABA receptors in acute and chronic repair phases of recovery. Zolpidem's good safety record and rapid absorption further indicate a need for more clinical trials. List of acronyms: BOLD, Blood-Oxygen-Level Dependent contrast imaging in MRI; CRS, Coma Recovery Scale; CRS-R, Coma Recovery Scale Revised; CSI, Cerebral State Index; CSM, Cerebral State Monitor; DOC, Disorder of Consciousness; EEG, Electro Encephalography; FDG-PET, FluoroDeoxyGlucose-Positron Emission Tomography; FTD, Frontotemporal dementia; GABA, Gamma-Aminobutyric Acid; MCS, Minimally Conscious State; M-EEG, Magneto-Encephalography; MRI, Magnetic Resonance Image; MSN, Median Spiny Neurones; PET, Positron Emission Tomography; PVS, Persistent Vegetative Sate; RLAC, Rancho Los Amigos Cognitive scores; SPECT, Single-photon emission computed tomography; TFES, Tinetti Falls Efficacy Scale; 99mTc HMPAO, Technetium hexamethylpropyleneamine oxime.

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