Zolpidem may be effective for prolonged disorders of consciousness
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SEATTLE — The use of 30 mg per day of zolpidem may significantly improve quality of life among patients with prolonged disorders of consciousness, a presenter said at the 2022 American Academy of Neurology annual meeting.
“There were a number of studies, where up to 40% of patients were thought to be in a permanently vegetative state, and were re-diagnosed ... as minimally conscious,” John W. Cassidy, MD, founder, CEO and chief medical officer of Nexus Health Systems, said during the presentation. “There is a somewhat better prognosis for that group of patients.”
Cassidy and colleagues investigated whether zolpidem — a nonbenzodiazepine approved by the FDA to treat insomnia — improved wakefulness and progression to a fully conscious state in patients with prolonged disorders of consciousness (PDOC) due to acquired brain injury.
In an uncontrolled study, researchers identified 75 patients who presented to the post-acute specialty neuroscience program at Nexus Health Systems between Oct. 1, 2018, and Jan. 31, 2021, with a confirmed diagnosis of PDOC. Patients were treated with 30 mg of zolpidem daily in divided doses.
Researchers used Coma Recovery Scale-Revised (CRS-R) scores to categorize alterations in consciousness after treatment. Patients who transitioned from unresponsive wakefulness syndrome or minimally conscious state minus (MCS–) to MCS+ or emergence from MCS (eMCS) were considered responsive.
Of the 75 patients, 29 (39%) progressed to MCS+ and 21 (28%) progressed to eMCS, while 17 responders (23%) reached and sustained a maximum CRS-R score of 23 and were subsequently discharged to a lower level of care to facilitate recovery. Non-responders had a significantly lower pre-treatment mean CRS-R score than responders (3 vs. 6, P < 0.001). The median duration of treatment was similar in both responders and non-responders (8.3 vs. 8 weeks, P = 0.86).
Researchers noted that neither age, sex nor etiology affected response to treatment.
“[This study] ... provides some valuable insights for clinicians just to consider in managing their DOC patients,” Cassidy said. “It has led to our considering and hopefully future launching of a randomized, controlled trial, which will help be more of a proof source for this information.”