Zolpidem for Persistent Vegetative State - A Placebo-Controlled Trial in Pediatrics

Abstract

Zolpidem was associated with a tendency towards reduced responsiveness in patients with persistent vegetative states. There were no objective changes on positron emission tomography suggestive of an associated increase in cerebral blood flow with zolpidem. It would appear that zolpidem does not offer a beneficial effect in this setting.

Zolpidem and Restoration of Consciousness

“…Similarities in these individuals' responses to zolpidem included (1) regaining consciousness within an hour of drug administration; (2) improved communication, speech, and command following lasting up to 4 hrs; and (3) returning to DOC after 4 hrs, consistent with the drug's pharmacokinetics. 14,15 The use of zolpidem, a widely prescribed hypnotic drug, to restore consciousness seems paradoxical, particularly given that most of the experimental attempts to positively influence neurologic recovery have focused on drugs with a more Balerting[ psychopharmacologic profile. 9,12 Improved consciousness of all individuals was replicated and maintained with repeated dosing.…”

Update on Pharmaceutical Intervention for Disorders of Consciousness and Agitation After Traumatic Brain Injury in Children

“…In addition, one very small prospective study of the use of zolpidem, an agent without a clear mechanism of action, has been performed in children in a persistent vegetative state. Drug dosing details, if provided in the literature cited in this article, are summarized in Table 1 [6‐10].…”

“…In addition, one very small prospective study of the use of zolpidem, an agent without a clear mechanism of action, has been performed in children in a persistent vegetative state. Drug dosing details, if provided in the literature cited in this article, are summarized in Table 1 [6][7][8][9][10]. [6] conducted a small randomized, double-blind, placebo-controlled crossover trial (Level of Evidence ϭ 2b) of amantadine in children (ages 6-18 years) with acquired brain injury (ABI).…”

A Narrative Review of Pharmacologic and Non-pharmacologic Interventions for Disorders of Consciousness Following Brain Injury in the Pediatric Population

“…The participants were given the medication for four days followed by ten days without medication, then four days of the other agent [27]. Outcome measures were the Rancho score, coma near coma scale, and positron emission tomography (PET) scan imaging (to look at cerebral glucose metabolism as a possible marker of increased brain activity).…”