Abstract
Objective: The aim of this study was to determine if zolpidem is associated with improved responsiveness
or regional cerebral perfusion in patients with persistent vegetative states.
Methods: Following ethics approval, children with persistent vegetative state were enrolled
in a prospective, double-blind, placebo-controlled randomised trial. Patients underwent
2 treatments of 4 days, separated by 10 days. Each child received either a daily dose
of zolpidem or placebo with a dosage of 0.14–0.2 mg/kg. Responsiveness and regional
cerebral perfusion were the outcomes of interest. These were assessed using the Rancho
levels of cognitive functioning scale, the coma/near-coma scale and F18-FDG positron emission tomography. These were conducted at baseline and after completion
of the treatments.
Results: 3 children were enrolled. The Rancho assessment scales showed no change with treatment.
The coma/near-coma scale showed a tendency to increase with zolpidem, suggesting reduced
responsiveness − when compared to baseline or placebo. The positron emission tomography
scans showed no significant changes between treatments.
Conclusion: Zolpidem was associated with a tendency towards reduced responsiveness in patients
with persistent vegetative states. There were no objective changes on positron emission
tomography suggestive of an associated increase in cerebral blood flow with zolpidem.
It would appear that zolpidem does not offer a beneficial effect in this setting.
Key words
persistent vegetative state - zolpidem - pediatrics - positron emission tomography
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Correspondence
Dr. Jonathan Egan
The Children's Hospital at
Westmead
Locked Bag 4001
Westmead 2145 Sydney
Australia
Phone: +61/2/9845 1990
Fax: +61/2/9845 1993
Email: jone@chw.edu.au
