Zolpidem in a minimally conscious state.
BACKGROUND
Case reports of the use of zolpidem in Permanent Vegetative States (PVS) have led to interest by the media and court judgements defining treatment with such drugs. It is uncertain whether this paradoxical effect of zolpidem in raising consciousness may be evident in other low awareness states such as Minimally Conscious State (MCS).


METHODS
This study treated a 44 year old male with MCS some 4 years after his traumatic brain injury with zolpidem for 1 week on and 1 week off treatment. Assessment with a number of tests by blinded therapists showed that his scores were no better on zolpidem and in some cases were worse on treatment.


CONCLUSIONS
Ideally a series of individuals is required to assess the effect of zolpidem, but in the light of positive spin stories in the media, negative case reports should also be highlighted. It is imperative that medical treatment in all instances and certainly in low awareness states and end of life decisions is always based on firm evidence.
Singh
Rajiv
R
Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, UK. rajiv.singh@lpct.scot.nhs.uk
McDonald
Clare
C
Dawson
Kirstin
K
Lewis
Sarah
S
Pringle
Anne-Marie
AM
Smith
Stephen
S
Pentland
Brian
B
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D004341:Drug Evaluation; D006801:Humans; D008297:Male; D018377:Neurotransmitter Agents / Q000627:therapeutic use*; D015588:Observer Variation; D018458:Persistent Vegetative State / Q000188:drug therapy* / Q000209:etiology; D011725:Pyridines / Q000008:administration & dosage*; D016896:Treatment Outcome; D000077334:Zolpidem
D018377:Neurotransmitter Agents; D011725:Pyridines; D000077334:Zolpidem