Zolpidem in Neurorehabilitation of Minimally Conscious Patient – a Case Report

Authors: K. Kotková 1;  Y. Angerová 1;  J. Kořenek 1;  K. Kupka 2;  O. Švestková 1
Authors‘ workplace: Klinika rehabilitačního lékařství, LF UK a VFN v Praze 1;  Ústav nukleární medicíny, LF UK a VFN v Praze 2
Published in: Cesk Slov Neurol N 2016; 79/112(3): 347-350
Category: Case Report


Neurorehabilitation also has to address the needs of patients in minimally conscious state (MCS). Zolpidem, a short acting non-benzodiazepine hypnotic, has been shown to induce paradoxical responses in some patients with MCS. We assessed zolpidem-induced changes using PET (pozitron emission tomography) in a patient with traumatic brain injury. The patient had PET at baseline and then 24 hours later after administration of zolpidem 10 mg, followed by a radioactive substance. After zolpidem, we observed significantly more intensive activity in the healthy temporal cortex of the right hemisphere. We attempted to utilize this transitory patient activity for training of new skills during a 3-month physiotherapy and occupational therapy programme. However, no development was seen. Similar experience has been described by several authors but they all advocate further research in the mechanism of action of zolpidem and appropriate diagnosis of MCS patients who might profit from its use.

Key words:
minimally conscious state – zolpidem – positron emission tomography – neurorehabilitation

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


1. Giacino J, Ashwal S, Childs N, et al. The minimal­ly conscious state: definition and dia­gnostic criteria. Neurology 2002;58(3):349–53.

2. Bruno MA, Vanhaudenhuyse A, Thibaut A, et al. From unresponsive wakefulness to minimal­ly conscious PLUS and functional locked-in syndromes: recent advances in our understand­ing of disorders of consciousnes­s. J Neurol 2011;258(7):1373–84. doi: 10.1007/s00415-011-6114-x.

3. Wil­liams ST, Conte MM, Goldfine AM, et al. Com­mon rest­ing brain dynamics indicate a pos­sible mechanism underly­ing zolpidem response in severe brain injury. Elife 2013;2:e01157. doi: 10.7554/eLife.01157.

4. Thon­nard M, Gos­series O, Demertzi A, et al. Ef­fect of zolpidem in chronic disorders of consciousnes­s: a prospective open-label study. Funct Neurol 2013;28(4):259– 64. doi: 10.11138/ FNeur/2013.28.4.259.

5. Whyte J, Myers R. Incidence of clinical­ly significant responses to zolpidem among patients with disorders of consciousnes­s: a preliminary placebo control­led trial. Am J Phys Med Rehabil 2009;88(5):410–8. doi: 10.1097/PHM.0b013e3181a0e3a0.

6. Chatel­le C, Thibaut A, Gros­series O, et al. Changes in cerebral metabolism in patients with a minimal­ly conscious state respond­ing to zolpidem. Front Hum Neurosci 2014;8:917. doi: 10.3389/fnhum.2014.00917.

7. Calabresi P, Centonze D, Bernardi G. Cel­lular factors control­l­ing neuronal vulnerability in the brain: a les­son from the striatum. Neurology 2000;55(9):1249–55.

8. Schiff ND. Recovery of consciousness after brain injury: a mesocircuit hypothesis. Trends Neurosci 2010;33(1):1–9. doi: 10.1016/j.tins.2009.11.002.

9. Pistoia F, Sara M, Sacco S, et al. Silenc­ing the brain may be better than stimulat­ing it. The GABA ef­fect. Curr Pharm Des 2014;20(26):4154–66.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2016 Issue 3

Most read in this issue
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account