Drugs Meant To Cause Sleeping May Affect Much More Than The REM Cycle

In 1999, Louis Viljoen, who had been in a vegetative state for three years, began to wake up. What caused this turn of events? A dose of zolpidem the doctor had prescribed for Louis’s apparent insomnia. Since then there has been a steady influx of similar cases – some doctors who tried zolpidem after hearing about Louis Viljoen and others who came upon it accidentally. However, this doesn’t mean that zolpidem is the new solution for every case – it didn’t work for everyone and for those it did work for the effects wore off after an hour or two. Nevertheless the few it did work for had been vegetative for years and were now finally waking up.

Previous to these cases many doctors believed that recovering from such vegetative states was impossible. After three months vegetative states were considered permanent if caused by oxygen deprivation and after one year if caused by blunt trauma. More and more scientific studies have been gathering information to prove that these injuries are more complex than first imagined. Nicholas Schiff, a neurologist, showed the deep brain stimulation can help such patients recover from an injury and even regain certain everyday abilities.

The advent of zolpidem being a possible resolution for these severe injuries has led to further investigation into the subject. The first large-scale clinical study on zolpidem began this year at Moss Rehabilitation Research Institute and the University of Pennsylvania. The study doesn’t hold a large amount of hope this far, however, since evidence suggests that less than 10% of brain-injured patients will actually wake up from their vegetative states after being given zolpidem. The question of how zolpidem awakens some patients and not the others is still unanswered and undergoing investigation. None of the accepted factors of prognosis such as age, health, and nature of the initial injury has correctly predicted which patients would reap the beneficial effects of Ambien.

The drug itself has been known to cause unusual behavior such as sleepwalking, sleepeating, sleeptalking, and even sleepdriving, scientists classify this as paradoxical excitation, but the mechanisms of how this drug awakens some patients from comas is still unknown. The study in Pennsylvania, led by Dr. John Whyte, plans to test 80 patients and then compare results of those who responded to the zoplidem and those who didn’t. They aim to look at anything that may explain the difference. Possible results range from certain brain regions lighting up to a particular pattern in firing neurons presenting in the awakening patients. The many unknowns make it difficult though since doctors don’t know which drug, what dosage, or what time in the patient’s recovery will actually work on the patients. The improvement due to zolpidem is rare and there’s no way of predicting who will respond favorably to such treatment, but the fact that such recovery is possible still offers many families hope that maybe just maybe their loved one will be one of the lucky few.

http://www.nytimes.com/2011/12/04/magazine/can-ambien-wake-minimally-conscious.html?_r=1&partner=rss&emc=rss