title: Zolpidem arousing effect in persistent vegetative state patients: autonomic, EEG and behavioral assessment.
abstract: OBJECTIVE
  To study the Zolpidem arousing effect in persistent vegetative state (PVS) patients combining clinical evaluation, autonomic assessment by heart rate variability (HRV), and EEG records.
  
  
  METHODS
  We studied a group of 8 PVS patients and other 8 healthy control subjects, matched by age and gender. The patients and controls received drug or placebo in two experimental sessions, separated by 10-14 days. The first 30 minutes of the session were considered the basal record, and then Zolpidem was administered. All participants were evaluated clinically, by EEG, and by HRV during the basal record, and for 90 minutes after drug intake.
  
  
  RESULTS
  We found in all patients, time-related arousing signs after Zolpidem intake: behavioral (yawns and hiccups), activation of EEG cortical activity, and a vagolytic chronotropic effect without a significant increment of the vasomotor sympathetic tone.
  
  
  CONCLUSIONS
  We demonstrated time-related arousing signs after Zolpidem intake. We discussed possible mechanisms to explain these patho-physiological findings regarding EEG cortical activation and an autonomic vagolytic drug effect. As this autonomic imbalance might induce cardiocirculatory complications, which we didn't find in any of our patients, we suggest developing future trials under control of physiological indices by bedside monitoring. However, considering that this arousing Zolpidem effect might be certainly related to brain function improvement, it should be particularly considered for the development of new neuro-rehabilitation programs in PVS cases. According to the literature review, we claim that this is the first report about the vagolitic effect of Zolpidem in PVS cases.
authors.forename: Calixto
authors.initials: C
authors.lastname: Machado
authors.forename: Mario
authors.initials: M
authors.lastname: Estévez
authors.forename: Rafael
authors.initials: R
authors.lastname: Rodríguez
authors.forename: Jesús
authors.initials: J
authors.lastname: Pérez-Nellar
authors.forename: Mauricio
authors.initials: M
authors.lastname: Chinchilla
authors.forename: Philip
authors.initials: P
authors.lastname: DeFina
authors.forename: Gerry
authors.initials: G
authors.lastname: Leisman
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Carrick
authors.forename: Robert
authors.initials: R
authors.lastname: Melillo
authors.forename: Adam
authors.initials: A
authors.lastname: Schiavi
authors.forename: Joel
authors.initials: J
authors.lastname: Gutiérrez
authors.forename: Maylén
authors.initials: M
authors.lastname: Carballo
authors.forename: Andrés
authors.initials: A
authors.lastname: Machado
authors.forename: Ana
authors.initials: A
authors.lastname: Olivares
authors.affiliation: Institute of Neurology and Neurosurgery, Department of Clinical Neurophysiology, 29 y D, Vedado, La Habana 10400, Cuba. braind@infomed.sld.cu.
authors.forename: Nuvia
authors.initials: N
authors.lastname: Pérez-Cruz
mesh_terms: D000293:Adolescent; D000328:Adult; D001341:Autonomic Nervous System / Q000187:drug effects* / Q000503:physiopathology; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D011725:Pyridines / Q000494:pharmacology* / Q000627:therapeutic use*; D055815:Young Adult; D000077334:Zolpidem
chemical_list: D011725:Pyridines; D000077334:Zolpidem