Abstract Details

Studies that have analyzed the usage of zolpidem for treating PDOC have shown conflicting results. In this study, we evaluated whether our zolpidem regimen promotes a progression towards a fully conscious state, and whether there are differences in response with respect to age, sex, etiology, and discharge destinations.

To evaluate whether zolpidem improves arousal and progress towards a fully conscious state in patients with prolonged disorders of consciousness (PDOC) due to acquired brain injury.

We identified patients who presented to the post-acute specialty neuroscience program at Nexus Health Systems between 01 October 2018 and 31 January 2021 with a confirmed diagnosis of PDOC, using retrospective review. Patients were treated with 30 mg/day in divided doses of zolpidem.

Coma Recovery Scale-Revised (CRS-R) scores were used to categorically assess changes in the level of consciousness in response to treatment. Patients who transitioned from the unresponsive wakefulness syndrome or minimally conscious state minus (MCS-) to MCS+ or emergence from MCS (eMCS), were considered as responders.

Of the 75 patients, 29(39%) transitioned to MCS+ and 21(28%) transitioned to eMCS. 17 responders (23%) reached and sustained a maximum CRS-R score of 23 and were discharged to lower level of care for further recovery.  Non-responders had a significantly lower pre-treatment mean CRS-R score than responders (3 vs 6, p < 0.001). The median duration of treatment was similar in both responders and non-responders (8.3 vs 8 weeks, p =0.86). No significant differences were observed according to sex, age, or etiology, between the response groups.

This study is a preliminary indicator that the use of 30 mg/day of zolpidem may lead to significant improvements in quality of life in a subset of patients with PDOC. Pre-treatment CRS-R scores may be a potential predictor of response. Further large-scale controlled investigation is needed to confirm causality and efficacy.