title: Clinical and brain SPECT scan response to zolpidem in patients after brain damage.
abstract: Previous reports document transient improvements after daily zolpidem (CAS 82626-48-0) in patients with brain damage. This multi-patient study evaluates the response to zolpidem in neurologically disabled patients, using 99mTcHMPAO brain SPECT scans and clinical rating scales.
  
  
  METHODS
  23 of 41 consecutive adult patients, at least 6 months after brain damage were identified as neurologically disabled patients by scoring less than 100/100 on the Barthel Index. Causes of their brain damage included stroke (n = 12), traumatic brain injury (n = 7), anaphylaxis (n = 2), drugs overdose (n = 1) and birth injury (n = 1). The selected 23 patients had a baseline 99mTcHMPAO brain SPECT scan before starting daily zolpidem therapy and a second within two weeks of therapy, performed 1 h after 10 mg oral zolpidem. Scans were designated as improved when at least two of three assessors detected improvement after zolpidem. The rest were designated non improved. After four months daily zolpidem therapy, patients were rated on the Tinetti Falls Efficacy Scale (TFES) before and after zolpidem. The TFES ratings were compared using a Wilcoxon non parametric signed rank test. Scan improvers were compared with non improvers, using a two sample t test with unequal variance.
  
  
  RESULTS
  Mean overall improvement after zolpidem on TFES was 11.3%, from 73.4/100 to 62.1/100 (p = 0.0001). 10/23 (43%) patients improved on SPECT scan after zolpidem. Their mean TFES improvement was 19.4% (+/- 16.75) compared with 5.08% (+/- 5.17) in 13/23 non improvers (p = 0.0081).
  
  
  CONCLUSIONS
  This prospective study adds further evidence to previous reports of zolpidem efficacy in patients with established brain damage.
authors.affiliation: Nuclear Medicine Department, University of Pretoria, South Africa.
authors.forename: Nozipho E
authors.initials: NE
authors.lastname: Nyakale
authors.forename: Ralf P
authors.initials: RP
authors.lastname: Clauss
authors.forename: Wally
authors.initials: W
authors.lastname: Nel
authors.forename: Mike
authors.initials: M
authors.lastname: Sathekge
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011725:Pyridines / Q000627:therapeutic use*; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D019690:Technetium Tc 99m Exametazime; D000077334:Zolpidem