Zolpidem promising for prolonged disorders of consciousness

A study presented at the 2022 Annual Meeting of the American Academy of Neurology (AAN 2022) suggests that 30-mg zolpidem improves consciousness and quality of life among patients suffering from prolonged disorders of consciousness (PDOC).

“Studies that have analysed the usage of zolpidem for treating PDOC have shown conflicting results,” the researchers said. “This study is a preliminary indicator that the use of 30 mg/day of zolpidem may lead to significant improvements in quality of life in a subset of patients with PDOC.”

“Further large-scale controlled investigation is needed to confirm causality and efficacy,” they added.

Between 1 October 2018 and 31 January 2021, 75 eligible patients were enrolled from the postacute specialty neuroscience programme at the Nexus Health Systems, all of whom were confirmed to have PDOC through a retrospective review. Zolpidem was administered at 30 mg/day in divided doses. The study did not include a control group.

The primary study endpoint was the change in level of patient consciousness in response to treatment, as measured by Coma Recovery Scale-Revised (CRS-R) scores. Patients who transitioned from having unresponsive wakefulness syndrome or minimally conscious state minus (MCS-) to either MCS+ or emergence from MCS (eMCS) were considered responsive to treatment.

Of the 75 participants, 29 (39 percent) transitioned to MCS+ and 21 (28 percent) to eMCS, and were deemed to be responders. Of note, 17 responders (23 percent) achieved and sustained the maximum CRS-R score of 23 and were eventually discharged to a lower level of care for further recovery. [Cassidy S., et al, AAN 2022]

The researchers then looked for potential indicators of treatment response. They found that nonresponders had significantly lower CRS-R scores before treatment than responders (mean, 3 vs 6; p<0.001), suggesting that preassessments could help predict treatment response.

Median duration of treatment was comparable between groups (8.3 vs 8 weeks; p=0.86), as was the distribution of age, sex, and disease aetiology. These factors were deemed unrelated to treatment response.

In a statement, John W. Cassidy, MD, the study’s primary author, said that the present study “provides some valuable insights for clinicians to consider in managing their DOC patients. It has led to our considering and hopefully future launching of a randomized, controlled trial, which will help be more of a proof source for this information.”

If proven to be clinically effective and safe, zolpidem could eventually help more patients achieve better consciousness status, leading to better clinical outcomes overall.

“There [have been] a number of studies, where up to 40 percent of patients were thought to be in a permanently vegetative state, and were rediagnosed ... as minimally conscious,” said Cassidy. “There is a somewhat better prognosis for that group of patients.”