Treating brain injury with a sleeping pill

New Scientist has a short report on recent research again suggesting that sleeping pill zolpidem (trade name Ambien) might help people with impaired consciousness after brain injury.

This comes after a 2006 study reported that zolpidem temporarily roused three brain-injured patients who were in a persistent vegetative state (PVS) a coma-like state of impaired consciousness.

Consequently, the media was full of new stories that described patients ‘waking’ from ‘coma’ after being given the drug.

The results were treated with some scepticism by the medical community, who are always suspicious of anything sounding like a ‘miracle cure’.

The plot thickened when zolpidem became the focus of a legal case last year when a UK court ruled that it could be given to a patient who had spent three years in a persistent vegetative state, against the wishes of the family.

In the event, the treatment didn’t work, and the patient was eventually allowed to die as the family wanted.

Interestingly, a new paper published in the medical journal Annals of Neurology reports similar results to the initial study, although this time in a patient with akinetic mutism rather than PVS.

Akinetic mutism is a state of absent motivation where a patient does not initiate any action or speech, although may sometimes be capable of it when prompted.

It usually occurs after severe frontal lobe damage or damage to subcortical areas that connect directly to the frontal lobes.

In this case, the patient became able to spontaneously move and walk after being given zolpidem.

Interestingly, the researchers also use a PET brain scan to see how blood flow to the brain changed after zolpidem when compared to placebo.

It turned out that the sleeping pill increased blood flow to the anterior cingulate and orbitofrontal cortices – both areas of the frontal lobe.

It seems the sleeping pill may have paradoxical and poorly understood effects on the damaged brain, but will need to be studied in much more detail to see if it is genuinely an effective treatment for people with certain types of brain injury.

Link to NewSci article ‘Sedative ‘reactivates’ damaged brains’.
Link to abstract of scientific study.

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