title: Zolpidem improves neuropsychiatric symptoms and motor dysfunction in a patient with Parkinson's disease after deep brain stimulation.
abstract: OBJECTIVE
  To illustrate the beneficial effect of zolpidem on the neuropsychiatric and motor symptoms in a patient with Parkinson disease (PD) after bilateral subthalamic nucleus deep brain stimulation.
  
  
  METHODS
  The 61-year-old housewife was diagnosed to have PD for 12 years with initial presentation of clumsiness and rest tremor of right limbs. She was referred to our hospital in March 2009 due to shortening of drug beneficial period since 3 years ago and on-phase dyskinesia in recent 2 years. Bilateral STN DBS was conducted on 18 June, 2009. Fluctuating spells of mental confusion were developed on the next day after surgery. Electric stimuli via DBS electrodes were delivered with parameters of 2 volts, 60 μs, 130 Hz on bilateral STN 32 days after DBS. The incoherent behaviors and motor fluctuation remained to occur. The beneficial effect of zolpidem on her neuropsychiatric and motor symptoms was detected incidentally in early July 2009. She could chat normally with her caregiver and walk with assistance after taking zolpidem. The beneficial period may last for 2 hours. Zolpidem was then given in dosage of 10 mg three times per day. The neuropsychiatric inventory was scored 56 during zolpidem 'off' and 30 during zolpidem 'on'. To understand the intriguing feature, we conducted FDG-PET during 'off' and 'on' zolpidem conditions. The results revealed that the metabolism was decreased in the right frontal, parietal cortex and caudate nucleus during zolpidem 'off'. These cool spots can be partially restored by zolpidem.
  
  
  CONCLUSIONS
  Zolpidem ameliorated the neuropsychiatric and parkinsonian motor symptom in the PD patient. Since GABAA benzodiazepine receptors are widely distributed throughout the central nervous system, zolpidem probably acts via modulating structures lying within the cortico-subcortical loop or by direct effect on these cortical regions.
authors.affiliation: Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hung-Yu
authors.initials: HY
authors.lastname: Huang
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Hsu
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Wu
authors.forename: Shang-Ming
authors.initials: SM
authors.lastname: Chiou
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
authors.forename: Mu-Chieh
authors.initials: MC
authors.lastname: Tsai
authors.forename: Chon-Haw
authors.initials: CH
authors.lastname: Tsai
mesh_terms: D003221:Confusion / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects*; D010300:Parkinson Disease / Q000628:therapy; D049268:Positron-Emission Tomography; D011569:Psychiatric Status Rating Scales; D011725:Pyridines / Q000627:therapeutic use*; D020530:Subthalamus / Q000502:physiology; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D019788:Fluorodeoxyglucose F18; D000077334:Zolpidem