Patient with Akinetic Mutism Speaks After Dose of Zolpidem

Both motor and verbal function improve soon after single dose of the insomnia drug

TUESDAY, March 13 (HealthDay News) -- A patient with long-term akinetic mutism due to a suicide attempt had a transient improvement in the ability to communicate and walk after a single dose of the insomnia drug zolpidem, according to a report published online March 13 in the Annals of Neurology.

Christine Brefel-Courbon, M.D., of the University Toulouse in Toulouse, France, and colleagues conducted a randomized, double-blind, placebo-controlled trial of zolpidem in the 48-year-old female patient, who had postanoxic encephalopathy due to an attempted suicide by hanging two years earlier. After the neurological injury, the patient had a severe reduction in motor and verbal spontaneous behavior, was completely dependent and was fed via gastrostomy.

About 20 minutes after her family treated her with zolpidem, the patient showed a three-hour improvement in the ability to walk, and was able to communicate with her family. The researchers conducted a blinded trial of zolpidem and placebo in the patient. Positron emission tomography studies identified increased activity in the frontal cortex and increased metabolism in the anterior cingulate and orbitofrontal cortices after drug treatment, but not placebo.

"Zolpidem induced a transient improvement in motor and cognitive performances," the authors write. "This paradoxical effect could result from an activation of limbic loops modulating motivational processes." The single patient study may be useful in studying other rare diseases, they add.

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