title: Zolpidem for persistent vegetative state--a placebo-controlled trial in pediatrics.
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 F (18)-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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rehabilitation Department, The Children's Hospital at Westmead, Westmead, Sydney, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Snyman
authors.forename: J R
authors.initials: JR
authors.lastname: Egan
authors.forename: K
authors.initials: K
authors.lastname: London
authors.forename: R
authors.initials: R
authors.lastname: Howman-Giles
authors.forename: D
authors.initials: D
authors.lastname: Gill
authors.forename: J
authors.initials: J
authors.lastname: Gillis
authors.forename: A
authors.initials: A
authors.lastname: Scheinberg
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D058787:GABA-A Receptor Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D018458:Persistent Vegetative State / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*; D011877:Radionuclide Imaging; D016896:Treatment Outcome; D000077334:Zolpidem
chemical_list: D058787:GABA-A Receptor Antagonists; D011725:Pyridines; D000077334:Zolpidem