1541 - Case Report: A Special Use for Zolpidem

Case Diagnosis: A 44-year-old-male with a history of ischemic left MCA/ACA territory infarct was admitted for multi-disciplinary rehabilitation with a diagnosis of a disorder of consciousness (DOC).

Case Description: Following resection of meningioma, the patient’s hospital course was complicated by an ischemic left MCA/ACA territory infarct due to left ICA occlusion. He then underwent a decompressive hemicraniectomy and eventually was transferred to inpatient rehabilitation (IPR) under the DOC program, where he progressed well. Several weeks later, he was sent out for a planned cranioplasty and was readmitted to IPR following surgery. On readmission to IPR, there was a question whether he had emerged from a level of unconsciousness or not, so he was trialed on zolpidem. Afterwards, family and therapists reported he had a positive response with prominent functional improvements including communication, which necessitated routine use of the medication.

Discussions: Zolpidem is primarily used for the short-term treatment of insomnia, so primarily a sedative effect. However, there are reports that it temporarily restores consciousness to a small portion of individuals in the chronic vegetative state. One group performed double-blind, placebo-controlled, crossover studies on individuals with a DOC to assess the frequency of clinically significant responses and identify characteristics of responders. Their results confirmed that clinical responses to zolpidem do occur in a minority of patients (5%) and can be replicated. However, they found that responders could not be distinguished in advance from the non-responders. A different retrospective study investigated the results of using zolpidem in persons with DOC. They showed an overall positive response rate (6%) similar to previous reports.

Conclusions: Screening all patients with a DOC using zolpidem should be considered. Further research should be done to elucidate the mechanism of zolpidem in enhancing consciousness and its potential role in treatment. Thus, a general guideline could be developed.