Zolpidem Arouses Patients in Vegetative State After Brain Injury: Quantitative Evaluation and Indications

Abstract

BackgroundTo investigate the efficacy and indications of Zolpidem, a nonbenzodiazepine hypnotic, inducing arousal in vegetative state patients after brain injury. MethodsOne hundred sixty-five patients were divided into 4 groups, according to area of brain damage and injury mechanism. All patients' brains were imaged by 99mTc-ECD single-photon emission computerized tomography (SPECT), before and 1hour after treatment with 10mg of zolpidem. Simultaneously, 3 quantitative indicators of brain function and damage were obtained using cerebral state monitor. Thirty-eight patients withdrew from the study after the first zolpidem dose. The remaining 127 patients received a daily dose of 10mg of zolpidem for 1week and were monitored again at the end of this week. ResultsOne hour after treatment with zolpidem, cerebral state index was increased and burst suppression reduced in both brain contrecoup contusion and space-occupying brain compression groups (P < 0.05). SPECT showed, 1hour after medication, that cerebral perfusion was improved in both brain contrecoup contusion and space-occupying brain compression groups, but no changes were seen in primary and secondary brain stem injury groups. In the 127 patients' group, after 1week of zolpidem treatment, all parameters obtained from cerebral state monitor were not statistically different compared with those after the initial medication (P > 0.05). ConclusionsZolpidem is an effective medicine to restore brain function in patients in vegetative state after brain injury, especially for those whose brain injuries are mainly in non-brain-stem areas. improvement of brain function is sudden rather than gradual.