A dose of the prescription sleep aid Ambien had the opposite effect on one French woman, awakening her from a two-year coma.
The 48-year-old woman suffered from akinetic mutism-a sort of persistent coma in which the patient is alert but can neither speak nor move. She had lain in this state after sustaining damage to the frontal lobe of her brain due to a lack of oxygen caused by an attempted suicide by hanging
But one day she was given zolpidem (Ambien) to treat ongoing insomnia.
"Twenty minutes later, her family noticed surprising signs of enhanced arousal," the study authors wrote, "She became able to communicate to her family, to eat without (swallowing) troubles, and to move alone in her bed. These effects started 20 minutes after drug administration and lasted for two to three hours."
After treatment, the patient could walk for short periods, and to speak if prompted, though not spontaneously. "This phenomenon was so reproducible that caregivers used to give her up to three tablets each day without sleepiness as a side effect," the researchers wrote.
Increased Blood Flow
Using positron emission tomography (PET) scans, the researchers found that the drug treatment caused the woman's frontal lobes to become "way more active," noted Dr. James Grisolia, a neurologist at Scripps Mercy Hospital in San Diego. He was not involved in the research, which was led by Dr. Christine Brefel-Courbon, of the University Hospital in Toulouse, France.
Speaking of the case, Grisolia said that it is a function of drugs like this that, besides from putting you to sleep, that they can also increase blood flow. And that activity apparently trumped the sleepiness caused by the medication in this one patient.
"This is a clinical mini-miracle that may give more insight into how the brain works," Grisolia added. "In the long run, it might help us to help other people that are in unresponsive or semicoma states."
According to Grisolia, other case reports have shown coma patients "awakening through stimulant medications, but never from a medication like zolpidem. How the drug worked its magic in this case remains unknown. "It needs case reports and further study in the lab to get a handle on this," he said.
Caution Advised
Dr. Tetsuo Ashizawa, professor and chairman of the department of neurology at the University of Texas Medical Branch, Galveston, called the report "interesting." But he cautioned against using such a single-patient study as a basis for treating other, seemingly similar cases.
"I understand the desire of the family member to give Ambien to patients" as a result of this study, he said, "but I would not tell them that they should expect improvement. As a physician, I would say this worked in this lady but it may not work in your father or mother, so they should not have unreal expectations. If it works, OK, but if it doesn't, don't be disappointed."
Still, Grisolia said he expects more reports on the effect of zolpidem in akinetic mutism will be published as a result of this study.
"I'm sure that anyone who has a relative in a long-term coma is going to be interested in having the doctor try Ambien and see if it makes a difference. So we may get more case reports very quickly," he said.
A spokeswoman for Sanofi-Aventis, the pharmaceutical company that manufactures Ambien, declined to comment on the study.
