Clinical and imaging evidence of zolpidem effect in hypoxic encephalopathy

Authors

  • Christine Brefel-Courbon MD,

    Corresponding author
    1. Department of Pharmacology and Centre Midi-Pyrenees de Pharmacovigilance, de Pharmacoepidemiologie et d'Informations sur le Medicament, Faculty of Medecine, University Toulouse, France
    2. Institut National de la Sante et de la Recherche Médicale U825, Toulouse University Hospital, Toulouse, France
    • Department of Pharmacology, Faculty of Medicine, 37 allées jules Guesde, 31000 Toulouse, France
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  • Pierre Payoux MD,

    1. Institut National de la Sante et de la Recherche Médicale U825, Toulouse University Hospital, Toulouse, France
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  • Fabierine Ory MD,

    1. Department of Neurology, Toulouse University Hospital, France
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  • Agnes Sommet MD,

    1. Department of Pharmacology and Centre Midi-Pyrenees de Pharmacovigilance, de Pharmacoepidemiologie et d'Informations sur le Medicament, Faculty of Medecine, University Toulouse, France
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  • Tarik Slaoui MD,

    1. Department of Neurology, Toulouse University Hospital, France
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  • Gaelle Raboyeau PhD,

    1. Institut National de la Sante et de la Recherche Médicale U825, Toulouse University Hospital, Toulouse, France
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  • Beatrice Lemesle MA,

    1. Department of Neurology, Toulouse University Hospital, France
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  • Michele Puel MD,

    1. Department of Neurology, Toulouse University Hospital, France
    2. Institut National de la Sante et de la Recherche Médicale U825, Toulouse University Hospital, Toulouse, France
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  • Jean-Louis Montastruc MD,

    1. Department of Pharmacology and Centre Midi-Pyrenees de Pharmacovigilance, de Pharmacoepidemiologie et d'Informations sur le Medicament, Faculty of Medecine, University Toulouse, France
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  • Jean-Francois Demonet PhD,

    1. Institut National de la Sante et de la Recherche Médicale U825, Toulouse University Hospital, Toulouse, France
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  • Dominique Cardebat PhD

    1. Institut National de la Sante et de la Recherche Médicale U825, Toulouse University Hospital, Toulouse, France
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    • Dr D. Cardebat is deceased.


Abstract

We conducted a randomized, double-blind, placebo-controlled, single-patient (N = 1) trial to evaluate the efficacy of zolpidem in a 48-year-old woman with an akinetic mutism. Motor and cognitive examinations and functional imaging were performed. Acute administration of zolpidem markedly improved motor performance and neuropsychological status. Cerebral metabolism (18F-fluorodeoxyglucose positron emission tomography) increased in postrolandic territories and in frontal cortex. Using the H215O positron emission tomography, we found a drug-induced activation in the anterior cingulate and orbitofrontal cortices. Zolpidem induced a transient improvement in motor and cognitive performances. This paradoxical effect could result from an activation of limbic loops modulating motivational processes. Ann Neurol 2007

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