Speech recovery after single-dose zolpidem in two minimally conscious patients with severe traumatic brain injuries: a case report

ABSTRACT

Background

In rare cases, zolpidem administration has been found to paradoxically improve cognition in patients with brain injury in disorders of consciousness.

Case Presentation

Two minimally conscious plus (MCS+) patients at baseline, a 24-year-old woman 8 weeks post-traumatic brain injury (TBI) and 23-year-old man 6 weeks post-TBI, demonstrated behavioral improvements after off-label, single-dose administration of 10 mg of zolpidem.

Discussion/Conclusion

The patients demonstrated improved cognition on Coma Recovery Scale-Revised assessment after ingesting zolpidem. In particular, speech was substantially restored as one patient recovered functional communication and both demonstrated intelligible verbalizations for the first-time post-injuries following zolpidem. Overall, evidence is limited regarding the underlying mechanisms of various cognitive improvements in zolpidem response although studies incorporating neuroimaging are promising. The outcomes and similarities between these cases contribute to the current literature and highlight the need for rigorous studies in the future to guide zolpidem trials in patient care for those with DOC.

KEYWORDS:

• Minimally conscious state
• severe brain injury
• zolpidem
• disorders of consciousness
• treatment

Disclosure statement

No potential conflict of interest was reported by the authors. These cases were retrospectively reported on following clinical decisions for medication administration and did not fall under ‘human research’ therefore IRB approval is not indicated.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.