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Zhou Y, Altonji KA, Kakkanatt A, Greenwald BD. Speech recovery after single-dose zolpidem in two minimally conscious patients with severe traumatic brain injuries: a case report. Brain Inj 2024; 38:337-340. [PMID: 38308526 DOI: 10.1080/02699052.2024.2311342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND In rare cases, zolpidem administration has been found to paradoxically improve cognition in patients with brain injury in disorders of consciousness. CASE PRESENTATION Two minimally conscious plus (MCS+) patients at baseline, a 24-year-old woman 8 weeks post-traumatic brain injury (TBI) and 23-year-old man 6 weeks post-TBI, demonstrated behavioral improvements after off-label, single-dose administration of 10 mg of zolpidem. DISCUSSION/CONCLUSION The patients demonstrated improved cognition on Coma Recovery Scale-Revised assessment after ingesting zolpidem. In particular, speech was substantially restored as one patient recovered functional communication and both demonstrated intelligible verbalizations for the first-time post-injuries following zolpidem. Overall, evidence is limited regarding the underlying mechanisms of various cognitive improvements in zolpidem response although studies incorporating neuroimaging are promising. The outcomes and similarities between these cases contribute to the current literature and highlight the need for rigorous studies in the future to guide zolpidem trials in patient care for those with DOC.
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Affiliation(s)
- Yi Zhou
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kathryn A Altonji
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Ashley Kakkanatt
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Brian D Greenwald
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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2
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Johnston PR, McIntosh AR, Meltzer JA. Spectral slowing in chronic stroke reflects abnormalities in both periodic and aperiodic neural dynamics. Neuroimage Clin 2023; 37:103277. [PMID: 36495856 PMCID: PMC9758570 DOI: 10.1016/j.nicl.2022.103277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
Decades of electrophysiological work have demonstrated the presence of "spectral slowing" in stroke patients - a prominent shift in the power spectrum towards lower frequencies, most evident in the vicinity of the lesion itself. Despite the reliability of this slowing as a marker of dysfunctional tissue across patient groups as well as animal models, it has yet to be explained in terms of the pathophysiological processes of stroke. To do so requires clear understanding of the neural dynamics that these differences represent, acknowledging the often overlooked fact that spectral power reflects more than just the amplitude of neural oscillations. To accomplish this, we used a combination of frequency domain and time domain measures to disambiguate and quantify periodic (oscillatory) and aperiodic (non-oscillatory) neural dynamics in resting state magnetoencephalography (MEG) recordings from chronic stroke patients. We found that abnormally elevated low frequency power in these patients was best explained by a steepening of the aperiodic component of the power spectrum, rather than an enhancement of low frequency oscillations, as is often assumed. However, genuine oscillatory activity at higher frequencies was also found to be abnormal, with patients showing alpha slowing and diminished oscillatory activity in the beta band. These aperiodic and periodic abnormalities were found to covary, and could be detected even in the un-lesioned hemisphere, however they were most prominent in perilesional tissue, where their magnitude was predictive of cognitive impairment. This work redefines spectral slowing as a pattern of changes involving both aperiodic and periodic neural dynamics and narrows the gap in understanding between non-invasive markers of dysfunctional tissue and disease processes responsible for altered neural dynamics.
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Affiliation(s)
- Phillip R Johnston
- Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON M5S 3G3, Canada; Rotman Research Institute, Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON M6A 2E1, Canada.
| | - Anthony R McIntosh
- Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive E K9625, Burnaby, BC V5A 1S6, Canada; Institute for Neuroscience and Neurotechnology, Simon Fraser University, 8888 University Drive E K9625, Burnaby, BC V5A 1S6, Canada
| | - Jed A Meltzer
- Department of Psychology, University of Toronto, 100 St. George Street, Toronto, ON M5S 3G3, Canada; Rotman Research Institute, Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON M6A 2E1, Canada; Department of Speech-Language Pathology, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada
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3
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Boisgontier J, Beccaria K, Saitovitch A, Blauwblomme T, Guida L, Fillon L, Dufour C, Grill J, Lemaitre H, Puget S, Vinçon-Leite A, Dangouloff-Ros V, Charpy S, Benichi S, Levy R, Roux CJ, Grévent D, Bourgeois M, Saidoun L, Gaillard R, Zilbovicius M, Boddaert N. Case Report: Zolpidem's paradoxical restorative action: A case report of functional brain imaging. Front Neurosci 2023; 17:1127542. [PMID: 37123350 PMCID: PMC10140395 DOI: 10.3389/fnins.2023.1127542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/09/2023] [Indexed: 05/02/2023] Open
Abstract
Zolpidem is a sedative drug that has been shown to induce a paradoxical effect, restoring brain function in wide range of neurological disorders. The underlying functional mechanism of the effect of zolpidem in the brain in clinical improvement is still poorly understood. Thus, we aimed to investigate rest brain function to study zolpidem-induced symptom improvement in a patient who developed postoperative pediatric cerebellar mutism syndrome, a postoperative complication characterized by delayed onset transient mutism/reduced speech that can occur after medulloblastoma resection. The patient experienced clinical recovery after a single dose of zolpidem. Brain function was investigated using arterial spin labeling MRI and resting-state functional MRI. Imaging was performed at three time-points: preoperative, postoperative during symptoms, and after zolpidem intake when the symptoms regressed. Whole brain rest cerebral blood flow (CBF) and resting state functional connectivity using Pearson coefficient correlations between pairs of regions of interest were investigated two-by-two at the different time points. A comparison between postoperative and preoperative images showed a significant decrease in rest CBF in the left supplementary motor area, Broca's area, and the left striatum and a decrease in functional connectivity within the dentato-thalamo-cortical and cortico-striato-pallido-thalamo-cortical loops. Post-zolpidem images showed increased CBF in the left striatum and increased functional connectivity within the disrupted loops relative to postoperative images. Thus, we observed functional changes within the broader speech network and thalamo-subcortical interactions associated with the paradoxical effect of zolpidem in promoting clinical recovery. This should encourage further functional investigations in the brain to better understand the mechanism of zolpidem in neurological recovery.
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Affiliation(s)
- Jennifer Boisgontier
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
- Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
- *Correspondence: Jennifer Boisgontier,
| | - Kévin Beccaria
- Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
| | - Ana Saitovitch
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
- Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
| | - Lelio Guida
- Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
| | - Ludovic Fillon
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
- Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - Jacques Grill
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - Hervé Lemaitre
- Neurodegenerative Diseases Institute, Neurofunctional Imaging Group (GIN), Univ. Bordeaux, CNRS, UMR 5293, Bordeaux, France
| | - Stéphanie Puget
- Department of Neurosurgery, Centre Hospitalier Universitaire de Fort de France, University of Antilles, Fort-de-France, Martinique
| | - Alice Vinçon-Leite
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
- Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
| | - Volodia Dangouloff-Ros
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
- Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
| | - Sarah Charpy
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
| | - Raphaël Levy
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
- Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
| | - Charles-Joris Roux
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
- Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
| | - David Grévent
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
| | - Marie Bourgeois
- Department of Pediatric Neurosurgery, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
| | - Lila Saidoun
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France
| | - Raphaël Gaillard
- Department of Psychiatry, Faculty of Medicine, Sainte-Anne Hospital, Université Paris Cité, Paris, France
| | - Monica Zilbovicius
- Ecole Normale Supérieure Paris-Saclay, INSERM U1299, ERL “Developmental Trajectories and Psychiatry”: Université Paris Saclay, Université de Paris, CNRS, Centre Borelli, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, AP-HP, Université Paris-Cité, Paris, France
- Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
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Capizzi A, Woo J, Magat E. Poststroke aphasia treatment: A review of pharmacologic therapies and noninvasive brain stimulation techniques. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cichon N, Wlodarczyk L, Saluk-Bijak J, Bijak M, Redlicka J, Gorniak L, Miller E. Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation. J Clin Med 2021; 10:jcm10173778. [PMID: 34501229 PMCID: PMC8432240 DOI: 10.3390/jcm10173778] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/07/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022] Open
Abstract
Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.
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Affiliation(s)
- Natalia Cichon
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
- Correspondence:
| | - Lidia Wlodarczyk
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland;
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland;
| | - Michal Bijak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Justyna Redlicka
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
| | - Leslaw Gorniak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Elzbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
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Grigoras IF, Stagg CJ. Recent advances in the role of excitation-inhibition balance in motor recovery post-stroke. Fac Rev 2021; 10:58. [PMID: 34308424 PMCID: PMC8265564 DOI: 10.12703/r/10-58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Stroke affects millions of people worldwide each year, and stroke survivors are often left with motor deficits. Current therapies to improve these functional deficits are limited, making it a priority to better understand the pathophysiology of stroke recovery and find novel adjuvant options. The excitation-inhibition balance undergoes significant changes post-stroke, and the inhibitory neurotransmitter γ-aminobutyric acid (GABA) appears to play an important role in stroke recovery. In this review, we summarise the most recent studies investigating GABAergic inhibition at different stages of stroke. We discuss the proposed role of GABA in counteracting glutamate-mediated excitotoxicity in hyperacute stroke as well as the evidence linking decreased GABAergic inhibition to increased neuronal plasticity in early stroke. Then, we discuss two types of interventions that aim to modulate the excitation-inhibition balance to improve functional outcomes in stroke survivors: non-invasive brain stimulation (NIBS) and pharmacological interventions. Finding the optimal NIBS administration or adjuvant pharmacological therapies would represent an important contribution to the currently scarce therapy options.
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Affiliation(s)
- Ioana-Florentina Grigoras
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford; Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford; Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
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7
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Zhang B, O’Brien K, Won W, Li S. A Retrospective Analysis on Clinical Practice-Based Approaches Using Zolpidem and Lorazepam in Disorders of Consciousness. Brain Sci 2021; 11:brainsci11060726. [PMID: 34072336 PMCID: PMC8226545 DOI: 10.3390/brainsci11060726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 12/03/2022] Open
Abstract
This is a retrospective study to investigate the results of using zolpidem and lorazepam in persons with disorders of consciousness (DoC) and to provide practical information for clinical application and further studies. The cohort included 146 patients (11 hemorrhagic stroke, 87 traumatic brain injury (TBI), 48 anoxic brain injury (ABI)) admitted to a specialized DoC rehabilitation program. A positive trial indicated a patient responded to either zolpidem or lorazepam with prominent functional improvements necessitating routine use of the medication. Non-responders had equivocal or negative (i.e., went to sleep) responses. Eleven patients with a stroke who had either medication were all non-responders. Of the remaining 135 patients, 95 received at least one medication trial. The overall positive rate was 11.6% (11/95), with 6.3% (5/79) for zolpidem and 14.0% (6/43) for lorazepam. Among TBI patients, the positive rate of the zolpidem trial (10.2%, 5/49) was slightly higher than that of the lorazepam trial (6.9%, 2/29; p > 0.05). Among ABI patients, the positive rate of the lorazepam trial (28.6%, 4/14) was significantly higher than that of the zolpidem trial (0%, 0/30; p = 0.007). Following a positive trial, most patients were continued on the medications on a regular basis before eventual discontinuation. Our results suggested the etiology of DoC, considering traumatic vs. anoxic injuries, may serve in guiding the clinical application of these medications in the treatment of DoC and in future prospective studies. We advocate for screening all patients with DoC using zolpidem and/or lorazepam.
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Affiliation(s)
- Bei Zhang
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (B.Z.); (W.W.)
- TIRR Disorders of Consciousness Program, TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
| | - Katherine O’Brien
- TIRR Disorders of Consciousness Program, TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - William Won
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (B.Z.); (W.W.)
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (B.Z.); (W.W.)
- TIRR Disorders of Consciousness Program, TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
- Correspondence:
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The Effect of Zolpidem on Language Function of Patients With Nonfluent Variant of Frontotemporal Dementia: A Pilot Study. Clin Neuropharmacol 2021; 44:81-84. [PMID: 33811198 DOI: 10.1097/wnf.0000000000000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Primary progressive aphasia (PPA), as the language variant of frontotemporal dementia, is a neurodegenerative disease with an insidious course that has no appropriate treatment yet. The present study evaluated the effect of zolpidem on improving language function in patients with nonfluent variant PPA (nfv-PPA). METHODS In this interventional pilot study, patients diagnosed with nfv-PPA were evaluated for language function through the Persian Aphasia Test. Patients were then treated with zolpidem with a maximum dose of 10 mg twice daily and reevaluated after 6 weeks using the Persian Aphasia Test. Data were compared by paired samples t test. Values of P ≤ 0.05 were considered significant. RESULTS Thirteen (8 men) patients completed the study. The mean age of the patients was 58.5 ± 4.5 years. Changes were statistically significant in none of the 6 subtests including spontaneous speech content, speech fluency, auditory comprehension, sequential command comprehension, repetition, and naming. CONCLUSION The study showed that zolpidem did not affect the improvement of language function in patients with nfv-PPA. Thus, traditional language structures do not seem to be sensitive to the modulatory effects of zolpidem. Studies with larger sample sizes will help support this hypothesis.
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Delorme C, Adanyeguh I, Bendetowicz D, Le Ber I, Ponchel A, Kas A, Habert MO, Mochel F. Multimodal neurometabolic investigation of the effects of zolpidem on leukoencephalopathy-related apathy. Eur J Neurol 2020; 27:2297-2302. [PMID: 32757342 DOI: 10.1111/ene.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The symptomatic effect of zolpidem on apathy has been reported in neurological disorders such as strokes and post-anoxic brain injuries, but not in white-matter disease of the brain. METHODS A 38-year-old patient presenting with severe apathy related to a genetic leukoencephalopathy but showing marked improvement of apathy after taking 10 mg of zolpidem was studied. To understand what may mediate such a clinical effect, a multimodal neurometabolic approach using 18 F fluorodeoxyglucose positron emission tomography (FDG-PET) and a dedicated magnetic resonance spectroscopy (MRS) sequence for gamma aminobutyric acid (GABA) and glutamine + glutamate metabolism was undertaken. RESULTS Pre-zolpidem FDG-PET showed hypometabolism in the orbitofrontal cortex, dorsolateral cortex and basal ganglia compared to healthy controls. Post-zolpidem, FDG-PET displayed increased metabolism in the orbitofrontal cortex together with improvement in the emotional and auto-activation domains of apathy. There was no improvement in the cognitive domain of apathy, and no change in metabolism in the dorsolateral frontal cortex. Post-zolpidem, MRS showed increased GABA and glutamine + glutamate levels in the frontal cortex and pallidum. CONCLUSION Our multimodal neurometabolic study suggests that the effects of zolpidem on apathy are related to increased metabolism in the orbitofrontal cortex and basal ganglia secondary to GABA modulation. Zolpidem may improve apathy in other white-matter disorders.
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Affiliation(s)
- C Delorme
- Department of Neurology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - I Adanyeguh
- UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France.,Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - D Bendetowicz
- Department of Neurology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France
| | - I Le Ber
- UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France.,Département de Neurologie, AP-HP - Hôpital Pitié-Salpêtrière, Reference Centre for Rare or Early Dementias, IM2A, Paris, France.,Institut du Cerveau et de la Moelle Epiniere (ICM), Frontlab, Paris, France
| | - A Ponchel
- Department of Neurology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France
| | - A Kas
- Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, Sorbonne Université, Paris, France.,Médecine Nucléaire, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - M-O Habert
- Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, Sorbonne Université, Paris, France.,Médecine Nucléaire, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - F Mochel
- UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, Paris, France.,Department of Genetics, AP-HP, Pitié-Salpêtrière University Hospital, Paris, France
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10
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Effect of Zolpidem in the Aftermath of Traumatic Brain Injury: An MEG Study. Case Rep Neurol Med 2020; 2020:8597062. [PMID: 32257474 PMCID: PMC7109561 DOI: 10.1155/2020/8597062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022] Open
Abstract
In the past two decades, many studies have shown the paradoxical efficacy of zolpidem, a hypnotic used to induce sleep, in transiently alleviating various disorders of consciousness such as traumatic brain injury (TBI), dystonia, and Parkinson's disease. The mechanism of action of this effect of zolpidem is of great research interest. In this case study, we use magnetoencephalography (MEG) to investigate a fully conscious, ex-coma patient who suffered from neurological difficulties for a few years due to traumatic brain injury. For a few years after injury, the patient was under medication with zolpidem that drastically improved his symptoms. MEG recordings taken before and after zolpidem showed a reduction in power in the theta-alpha (4–12 Hz) and lower beta (15–20 Hz) frequency bands. An increase in power after zolpidem intake was found in the higher beta/lower gamma (20–43 Hz) frequency band. Source level functional connectivity measured using weighted-phase lag index showed changes after zolpidem intake. Stronger connectivity between left frontal and temporal brain regions was observed. We report that zolpidem induces a change in MEG resting power and functional connectivity in the patient. MEG is an informative and sensitive tool to detect changes in brain activity for TBI.
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Vasenina E, Levin O. Speech disorders and anxiety: interaction mechanisms and therapy potential. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:136-144. [DOI: 10.17116/jnevro2020120041136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Regenhardt RW, Takase H, Lo EH, Lin DJ. Translating concepts of neural repair after stroke: Structural and functional targets for recovery. Restor Neurol Neurosci 2020; 38:67-92. [PMID: 31929129 PMCID: PMC7442117 DOI: 10.3233/rnn-190978] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Stroke is among the most common causes of adult disability worldwide, and its disease burden is shifting towards that of a long-term condition. Therefore, the development of approaches to enhance recovery and augment neural repair after stroke will be critical. Recovery after stroke involves complex interrelated systems of neural repair. There are changes in both structure (at the molecular, cellular, and tissue levels) and function (in terms of excitability, cortical maps, and networks) that occur spontaneously within the brain. Several approaches to augment neural repair through enhancing these changes are under study. These include identifying novel drug targets, implementing rehabilitation strategies, and developing new neurotechnologies. Each of these approaches has its own array of different proposed mechanisms. Current investigation has emphasized both cellular and circuit-based targets in both gray and white matter, including axon sprouting, dendritic branching, neurogenesis, axon preservation, remyelination, blood brain barrier integrity, blockade of extracellular inhibitory signals, alteration of excitability, and promotion of new brain cortical maps and networks. Herein, we review for clinicians recovery after stroke, basic elements of spontaneous neural repair, and ongoing work to augment neural repair. Future study requires alignment of basic, translational, and clinical research. The field continues to grow while becoming more clearly defined. As thrombolysis changed stroke care in the 1990 s and thrombectomy in the 2010 s, the augmentation of neural repair and recovery after stroke may revolutionize care for these patients in the coming decade.
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Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Hajime Takase
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Eng H Lo
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - David J Lin
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
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13
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Feng YW, Huang YQ, Yan Y, Li G, He XF, Liang FY, Pei Z, Lan Y, Xu GQ. Phasic GABA signaling mediates the protective effects of cTBS against cerebral ischemia in mice. Neurosci Lett 2019; 715:134611. [PMID: 31698026 DOI: 10.1016/j.neulet.2019.134611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/25/2019] [Accepted: 11/03/2019] [Indexed: 01/26/2023]
Abstract
Continuous theta burst stimulation (cTBS) has been widely recognized as a therapeutic treatment for ischemic stroke, but the underlying mechanism is still elusive. Here, we investigated the protective effects of cTBS in the posterior parietal cortex during the chronic phase of stroke in the photothrombotic ischemic model. Infarction volume and neuron excitability in the peri-infarct area were assessed using immunohistochemistry and whole-cell patch-clamp. Spatial cognitive function was measured using the Morris water maze. Gamma-Amino butyric acid (GABA) interneurons were responsive to cTBS, and cTBS induced elevated phasic inhibition rather than tonic inhibition. Given that GABA-A-mediated phasic inhibition was elevated during the chronic phase of ischemic stroke for 30 days and was beneficial for stroke recovery, we investigated the therapeutic potential of cTBS in promoting functional recovery and found that the elevated phasic inhibition by cTBS improved spatial cognitive function in the photothrombotic stroke mouse model with induction in the posterior parietal cortex. Our study indicates the mechanism by which cTBS may modify the excitability of the brain cortex and provides novel insight into the potential of cTBS to protect against neuronal dysfunction in ischemic stroke.
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Affiliation(s)
- Yi-Wei Feng
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Qing Huang
- Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Department of Rehabilitation Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Yan
- Research Center of Basic Medical Sciences, School of Basic Medical Sciences, Hubei University of Science and Technology, 88 Xianning Road, Xianning, 437100, Hubei, China
| | - Ge Li
- Guangdong Provincial Key Laboratory of Laboratory Animals, Guangdong Laboratory Animals Monitoring Institute, Guangzhou, China
| | - Xiao-Fei He
- Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Feng-Yin Liang
- Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhong Pei
- Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou, China; Department of Rehabilitation Medicine, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China.
| | - Guang-Qing Xu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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14
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Treatment of Catatonia in Frontotemporal Dementia: A Lesson From Zolpidem Test. Clin Neuropharmacol 2019; 42:186-187. [DOI: 10.1097/wnf.0000000000000362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Cohen L, Ponchel A, Kas A, Ströer S, Del Cul A, Guérineau de Lamérie G, El Hachem R, Crépin P, Morin A. Recovery from cortical blindness with mepivacaïne. Ann Clin Transl Neurol 2019; 6:1541-1545. [PMID: 31402624 PMCID: PMC6689678 DOI: 10.1002/acn3.50832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/05/2022] Open
Abstract
We report the case of a patient suffering from cortical blindness following bilateral occipital stroke, who recovered normal vision in his right visual field following injection of the local anesthetic mepivacaïne. The effect was transient but reproducible, allowing the patient to lead a normal life. Effect duration increased after adjunction of paroxetine. We provide anatomical and functional brain imaging correlates of this improvement, showing particularly how functional connectivity is restored between intact perilesional cortex and distant brain regions. This serendipitous finding may potentially benefit patients suffering from visual but also nonvisual handicap following brain lesions.
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Affiliation(s)
- Laurent Cohen
- Institut du Cerveau et de la Moelle épinière, ICM, Sorbonne Université, Inserm U 1127, CNRS UMR 7225, F-75013, Paris, France.,Département de neurologie, Hôpital de la Pitié Salpêtrière, AP-HP, F-75013, Paris, France
| | - Amélie Ponchel
- Institut du Cerveau et de la Moelle épinière, ICM, Sorbonne Université, Inserm U 1127, CNRS UMR 7225, F-75013, Paris, France.,Département de neurologie, Hôpital de la Pitié Salpêtrière, AP-HP, F-75013, Paris, France
| | - Aurélie Kas
- Service de médecine nucléaire, Hôpital de la Pitié Salpêtrière, AP-HP, F-75013, Paris, France
| | - Sébastian Ströer
- Service de neuroradiologie, Hôpital de la Pitié Salpêtrière, AP-HP, F-75013, Paris, France
| | - Antoine Del Cul
- Service de psychiatrie, Hôpital de la Pitié Salpêtrière, AP-HP, F-75013, Paris, France
| | | | - Randa El Hachem
- Service d'anesthésie, Centre Hospitalier, 11100, Narbonne, France
| | - Piirika Crépin
- Centre Medico Psycho Pédagogique, 11100, Narbonne, France
| | - Alexandre Morin
- Département de neurologie, Hôpital de la Pitié Salpêtrière, AP-HP, F-75013, Paris, France
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16
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Clarkson AN, Boothman-Burrell L, Dósa Z, Nagaraja RY, Jin L, Parker K, van Nieuwenhuijzen PS, Neumann S, Gowing EK, Gavande N, Ahring PK, Holm MM, Hanrahan JR, Nicolazzo JA, Jensen K, Chebib M. The flavonoid, 2'-methoxy-6-methylflavone, affords neuroprotection following focal cerebral ischaemia. J Cereb Blood Flow Metab 2019; 39:1266-1282. [PMID: 29376464 PMCID: PMC6668512 DOI: 10.1177/0271678x18755628] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Tonic inhibitory currents, mediated by extrasynaptic GABAA receptors, are elevated at a delay following stroke. Flavonoids minimise the extent of cellular damage following stroke, but little is known about their mode of action. We demonstrate that the flavonoid, 2'-methoxy-6-methylflavone (0.1-10 µM; 2'MeO6MF), increases GABAA receptor tonic currents presumably via δ-containing GABAA receptors. Treatment with 2'MeO6MF 1-6 h post focal ischaemia dose dependently decreases infarct volume and improves functional recovery. The effect of 2'MeO6MF was attenuated in δ-/- mice, indicating that the effects of the flavonoid were mediated via δ-containing GABAA receptors. Further, as flavonoids have been shown to have multiple modes of action, we investigated the anti-inflammatory effects of 2'MeO6MF. Using a macrophage cell line, we show that 2'MeO6MF can dampen an LPS-induced elevation in NFkB activity. Assessment of vehicle-treated stroke animals revealed a significant increase in circulating IL1β, TNFα and IFγ levels. Treatment with 2'MeO6MF dampened the stroke-induced increase in circulating cytokines, which was blocked in the presence of the pan-AKT inhibitor, GSK690693. These studies support the hypothesis that compounds that potentiate tonic inhibition via δ-containing GABAA receptors soon after stroke can afford neuroprotection.
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Affiliation(s)
- Andrew N Clarkson
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand.,2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Lily Boothman-Burrell
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Zita Dósa
- 3 Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Raghavendra Y Nagaraja
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Liang Jin
- 4 Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Kim Parker
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | | | - Silke Neumann
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand.,5 Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Emma K Gowing
- 1 Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Navnath Gavande
- 2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Philip K Ahring
- 2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Mai M Holm
- 3 Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Jane R Hanrahan
- 2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Joseph A Nicolazzo
- 4 Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Kimmo Jensen
- 3 Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Mary Chebib
- 2 Faculty of Pharmacy, The University of Sydney, Sydney, Australia
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17
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Hartwigsen G, Saur D. Neuroimaging of stroke recovery from aphasia - Insights into plasticity of the human language network. Neuroimage 2017; 190:14-31. [PMID: 29175498 DOI: 10.1016/j.neuroimage.2017.11.056] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
The role of left and right hemisphere brain regions in language recovery after stroke-induced aphasia remains controversial. Here, we summarize how neuroimaging studies increase the current understanding of functional interactions, reorganization and plasticity in the language network. We first discuss the temporal dynamics across the time course of language recovery, with a main focus on longitudinal studies from the acute to the chronic phase after stroke. These studies show that the functional contribution of perilesional and spared left hemisphere as well as contralesional right hemisphere regions to language recovery changes over time. The second section introduces critical variables and recent advances on early prediction of subsequent outcome. In the third section, we outline how multi-method approaches that combine neuroimaging techniques with non-invasive brain stimulation elucidate mechanisms of plasticity and reorganization in the language network. These approaches provide novel insights into general mechanisms of plasticity in the language network and might ultimately support recovery processes during speech and language therapy. Finally, the neurobiological correlates of therapy-induced plasticity are discussed. We argue that future studies should integrate individualized approaches that might vary the combination of language therapy with specific non-invasive brain stimulation protocols across the time course of recovery. The way forward will include the combination of such approaches with large data sets obtained from multicentre studies.
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Affiliation(s)
- Gesa Hartwigsen
- Research Group Modulation of Language Networks, Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Dorothee Saur
- Language & Aphasia Laboratory, Department of Neurology, University of Leipzig, Germany.
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18
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Abstract
Approximately, five million people in the United States live with the residual effects of brain injury. The causes of acquired brain injury can be categorized as traumatic brain injury or non-traumatic brain injury. There are currently no treatments shown to consistently enhance recovery from disorders of consciousness (DOC). Sporadic recovery from DOC after the administration of various pharmacological agents has been described in several case reports. Increase in arousal after zolpidem administration is seen in patients with vegetative state or minimally conscious state for treatment of restlessness and disturbances of their sleep-wake cycle. The use of zolpidem could be reasonable in select patients with neurologic injury but promising integrity of brain structures, such as intact deep and superficial gray matter structures and white matter connections.
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Affiliation(s)
- Calvin Tucker
- Clinical Pharmacist, Critical Care, St. Vincent's Medical Center, 1 Shircliff Way, Jacksonville, FL, 32204, USA.
| | - Kirsten Sandhu
- Clinical Pharmacist, Critical Care, St. Vincent's Medical Center, 1 Shircliff Way, Jacksonville, FL, 32204, USA
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19
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Saxena S, Hillis AE. An update on medications and noninvasive brain stimulation to augment language rehabilitation in post-stroke aphasia. Expert Rev Neurother 2017; 17:1091-1107. [PMID: 28847186 DOI: 10.1080/14737175.2017.1373020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Aphasia is among the most debilitating outcomes of stroke. Aphasia is a language disorder occurring in 10-30% of stroke survivors. Speech and Language Therapy (SLT) is the gold standard, mainstay treatment for aphasia, but gains from SLT may be incomplete. Pharmaceutical and noninvasive brain stimulation (NIBS) techniques may augment the effectiveness of SLT. Areas covered: Herein reviewed are studies of the safety and efficacy of these adjunctive interventions for aphasia, including randomized placebo-controlled and open-label trials, as well as case series from Pubmed, using search terms 'pharmacological,' 'tDCS' or 'TMS' combined with 'aphasia' and 'stroke.' Expert commentary: Relatively small studies have included participants with a range of aphasia types and severities, using inconsistent interventions and outcome measures. Results to-date have provided promising, but weak to moderate evidence that medications and/or NIBS can augment the effects of SLT for improving language outcomes. We end with recommendations for future approaches to studying these interventions, with multicenter, double-blind, randomized controlled trials.
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Affiliation(s)
- Sadhvi Saxena
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Argye E Hillis
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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20
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Noormandi A, Shahrokhi M, Khalili H. Potential benefits of zolpidem in disorders of consciousness. Expert Rev Clin Pharmacol 2017. [PMID: 28649875 DOI: 10.1080/17512433.2017.1347502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION It has been suggested that zolpidem may arouse patients with decreased level of consciousness. Zolpidem may partially or even completely reverse abnormal cell metabolism following brain damage. In this article, available evidences regarding effects of zolpidem on disorders of consciousness were reviewed. Areas covered: A literature review was conducted using PubMed, Scopus, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Google Scholar as online databases. Search Keywords were 'vegetative state', 'minimally conscious state', 'semi-comatose', 'arousal', 'zolpidem', 'wakefulness', 'awareness', and 'loss of consciousness'. All English language studies that evaluated the effects of zolpidem on disorders of consciousness as a main surrogate endpoint were included. Finally 21 articles within this subject were included. Expert commentary: Zolpidem showed positive effects in several conditions with decreased level of consciousness. However, benefits of zolpidem were not detected in all patients with disorders of consciousness. Patients with post-anoxic encephalopathy or traumatic brain injury did not experience benefits of zolpidem. Available evidences support positive effects of zolpidem on brain functions in patients with non-brain stem injuries.
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Affiliation(s)
- Afsaneh Noormandi
- a Department of Clinical Pharmacy, Faculty of Pharmacy , Tehran University of Medical Sciences , Tehran , Iran
| | - Maryam Shahrokhi
- a Department of Clinical Pharmacy, Faculty of Pharmacy , Tehran University of Medical Sciences , Tehran , Iran
| | - Hossein Khalili
- a Department of Clinical Pharmacy, Faculty of Pharmacy , Tehran University of Medical Sciences , Tehran , Iran
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21
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Sutton JA, Clauss RP. A review of the evidence of zolpidem efficacy in neurological disability after brain damage due to stroke, trauma and hypoxia: A justification of further clinical trials. Brain Inj 2017; 31:1019-1027. [PMID: 28534652 DOI: 10.1080/02699052.2017.1300836] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
During 15 years, 23 clinical reports and 6 studies have demonstrated associations between sub-sedative doses of zolpidem and recoveries from brain damage due to strokes, trauma and hypoxia. Clinical findings include unexpected awakenings from vegetative states and regressions of stroke symptoms after dosing that disappear during elimination and reappear on repeat dosing. Initially single-photon emission computed tomography scans showed improved perfusion within, around and distant from infarctions. Then positron emission tomography scans and electroencephalography detected renewed metabolic and neuronal activity. Placebo or a similar, gamma-aminobutyric acid (GABA)-ergic, sedative zopiclone has no such effect. The effect appears only several months after the injury, reflecting recent evidence in mice of substantial differences between the states of GABA receptors in acute and chronic repair phases of recovery. Zolpidem's good safety record and rapid absorption further indicate a need for more clinical trials. List of acronyms: BOLD, Blood-Oxygen-Level Dependent contrast imaging in MRI; CRS, Coma Recovery Scale; CRS-R, Coma Recovery Scale Revised; CSI, Cerebral State Index; CSM, Cerebral State Monitor; DOC, Disorder of Consciousness; EEG, Electro Encephalography; FDG-PET, FluoroDeoxyGlucose-Positron Emission Tomography; FTD, Frontotemporal dementia; GABA, Gamma-Aminobutyric Acid; MCS, Minimally Conscious State; M-EEG, Magneto-Encephalography; MRI, Magnetic Resonance Image; MSN, Median Spiny Neurones; PET, Positron Emission Tomography; PVS, Persistent Vegetative Sate; RLAC, Rancho Los Amigos Cognitive scores; SPECT, Single-photon emission computed tomography; TFES, Tinetti Falls Efficacy Scale; 99mTc HMPAO, Technetium hexamethylpropyleneamine oxime.
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Affiliation(s)
- J A Sutton
- a ReGen Therapeutics plc and Guildford Clinical Pharmacology Ltd. , Midhurst , West Sussex , UK
| | - R P Clauss
- b Department of Nuclear Medicine , Royal Surrey County Hospital , Guildford , Surrey , UK
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Abstract
Stroke is the leading cause of complex adult disability in the world. Recovery from stroke is often incomplete, which leaves many people dependent on others for their care. The improvement of long-term outcomes should, therefore, be a clinical and research priority. As a result of advances in our understanding of the biological mechanisms involved in recovery and repair after stroke, therapeutic opportunities to promote recovery through manipulation of poststroke plasticity have never been greater. This work has almost exclusively been carried out in preclinical animal models of stroke with little translation into human studies. The challenge ahead is to develop a mechanistic understanding of recovery from stroke in humans. Advances in neuroimaging techniques now enable us to reconcile behavioural accounts of recovery with molecular and cellular changes. Consequently, clinical trials can be designed in a stratified manner that takes into account when an intervention should be delivered and who is most likely to benefit. This approach is expected to lead to a substantial change in how restorative therapeutic strategies are delivered in patients after stroke.
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Zolpidem is a potent stoichiometry-selective modulator of α1β3 GABAA receptors: evidence of a novel benzodiazepine site in the α1-α1 interface. Sci Rep 2016; 6:28674. [PMID: 27346730 PMCID: PMC4921915 DOI: 10.1038/srep28674] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/06/2016] [Indexed: 12/16/2022] Open
Abstract
Zolpidem is not a typical GABAA receptor hypnotic. Unlike benzodiazepines, zolpidem modulates tonic GABA currents in the rat dorsal motor nucleus of the vagus, exhibits residual effects in mice lacking the benzodiazepine binding site, and improves speech, cognitive and motor function in human patients with severe brain injury. The receptor by which zolpidem mediates these effects is not known. In this study we evaluated binary α1β3 GABAA receptors in either the 3α1:2β3 or 2α1:3β3 subunit stoichiometry, which differ by the existence of either an α1-α1 interface, or a β3-β3 interface, respectively. Both receptor stoichiometries are readily expressed in Xenopus oocytes, distinguished from each other by using GABA, zolpidem, diazepam and Zn2+. At the 3α1:2β3 receptor, clinically relevant concentrations of zolpidem enhanced GABA in a flumazenil-sensitive manner. The efficacy of diazepam was significantly lower compared to zolpidem. No modulation by either zolpidem or diazepam was detected at the 2α1:3β3 receptor, indicating that the binding site for zolpidem is at the α1-α1 interface, a site mimicking the classical α1-γ2 benzodiazepine site. Activating α1β3 (3α1:2β3) receptors may, in part, mediate the physiological effects of zolpidem observed under distinct physiological and clinical conditions, constituting a potentially attractive drug target.
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24
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Can a Positive Allosteric Modulation of GABAergic Receptors Improve Motor Symptoms in Patients with Parkinson's Disease? The Potential Role of Zolpidem in the Treatment of Parkinson's Disease. PARKINSONS DISEASE 2016; 2016:2531812. [PMID: 27293955 PMCID: PMC4886078 DOI: 10.1155/2016/2531812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/22/2016] [Accepted: 04/07/2016] [Indexed: 12/22/2022]
Abstract
At present, patients with advanced Parkinson's disease (PD) are unsatisfactorily controlled by currently used anti-Parkinsonian dopaminergic drugs. Various studies suggest that therapeutic strategies based on nondopaminergic drugs might be helpful in PD. Zolpidem, an imidazopyridine widely used as sleep inducer, shows high affinity only for GABAA receptors containing the α-1 subunit and facilitates GABAergic neurotransmission through a positive allosteric modulation of GABAA receptors. Various observations, although preliminary, consistently suggest that in PD patients zolpidem may induce beneficial (and sometimes remarkable) effects on motor symptoms even after single doses and may also improve dyskinesias. Since a high density of zolpidem binding sites is in the two main output structures of the basal ganglia which are abnormally overactive in PD (internal globus pallidus, GPi, and substantia nigra pars reticulata, SNr), it was hypothesized that in PD patients zolpidem may induce through GABAA receptors an inhibition of GPi and SNr (and, possibly, of the subthalamic nucleus also), resulting in an increased activity of motor cortical areas (such as supplementary motor area), which may give rise to improvement of motor symptoms of PD. Randomized clinical trials are needed in order to assess the efficacy, safety, and tolerability of zolpidem in treating motor symptoms of PD.
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25
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Kielar A, Deschamps T, Chu RKO, Jokel R, Khatamian YB, Chen JJ, Meltzer JA. Identifying Dysfunctional Cortex: Dissociable Effects of Stroke and Aging on Resting State Dynamics in MEG and fMRI. Front Aging Neurosci 2016; 8:40. [PMID: 26973515 PMCID: PMC4776400 DOI: 10.3389/fnagi.2016.00040] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/15/2016] [Indexed: 11/13/2022] Open
Abstract
Spontaneous signals in neuroimaging data may provide information on cortical health in disease and aging, but the relative sensitivity of different approaches is unknown. In the present study, we compared different but complementary indicators of neural dynamics in resting-state MEG and BOLD fMRI, and their relationship with blood flow. Participants included patients with post-stroke aphasia, age-matched controls, and young adults. The complexity of brain activity at rest was quantified in MEG using spectral analysis and multiscale entropy (MSE) measures, whereas BOLD variability was quantified as the standard deviation (SDBOLD), mean squared successive difference (MSSD), and sample entropy of the BOLD time series. We sought to assess the utility of signal variability and complexity measures as markers of age-related changes in healthy adults and perilesional dysfunction in chronic stroke. The results indicate that reduced BOLD variability is a robust finding in aging, whereas MEG measures are more sensitive to the cortical abnormalities associated with stroke. Furthermore, reduced complexity of MEG signals in perilesional tissue were correlated with hypoperfusion as assessed with arterial spin labeling (ASL), while no such relationship was apparent with BOLD variability. These findings suggest that MEG signal complexity offers a sensitive index of neural dysfunction in perilesional tissue in chronic stroke, and that these effects are clearly distinguishable from those associated with healthy aging.
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Affiliation(s)
- Aneta Kielar
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
| | - Tiffany Deschamps
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
| | - Ron K. O. Chu
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
- Department of Psychology, University of TorontoToronto, ON, Canada
| | - Regina Jokel
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
- Department of Speech-Language Pathology, University of TorontoToronto, ON, Canada
| | | | - Jean J. Chen
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
- Canadian Partnership for Stroke RecoveryOttawa, ON, Canada
| | - Jed A. Meltzer
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
- Department of Psychology, University of TorontoToronto, ON, Canada
- Department of Speech-Language Pathology, University of TorontoToronto, ON, Canada
- Canadian Partnership for Stroke RecoveryOttawa, ON, Canada
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Walker-Batson D, Mehta J, Smith P, Johnson M. Amphetamine and other pharmacological agents in human and animal studies of recovery from stroke. Prog Neuropsychopharmacol Biol Psychiatry 2016; 64:225-30. [PMID: 25896190 DOI: 10.1016/j.pnpbp.2015.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 11/15/2022]
Abstract
Neuromodulation with pharmacological agents, including drugs of abuse such as amphetamine, when paired with behavioral experience, has been shown to positively modify outcomes in animal models of stroke. A number of clinical studies have tested the efficacy of a variety of drugs to enhance recovery of language deficit post-stroke. The purpose of this paper is to: (1) present pertinent animal studies supporting the use of dextro-amphetamine sulfate (AMPH) to enhance recovery after experimental lesions with emphasis on the importance of learning dependent activity for lasting recovery; (2) briefly review neuropharmacological explorations in the treatment of aphasia; (3) present a pilot study in aphasia exploring a drug combination of AMPH and donepezil hydrochloride paired with behavioral treatment to facilitate recovery; and (4) conclude with comments regarding the role of adjunctive pharmacotherapy in the rehabilitation of aphasia, particularly AMPH.
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Affiliation(s)
- D Walker-Batson
- The Stroke Center-Dallas, T. Boone Pickens Institute of Health Sciences, Texas Woman's University, 5500 Southwestern Medical Avenue, Dallas, TX 75235, United States.
| | - J Mehta
- The Stroke Center-Dallas, T. Boone Pickens Institute of Health Sciences, Texas Woman's University, 5500 Southwestern Medical Avenue, Dallas, TX 75235, United States
| | - P Smith
- Department of Physical Therapy, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235, United States
| | - M Johnson
- Department of Neurology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8897, United States
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Hiu T, Farzampour Z, Paz JT, Wang EHJ, Badgely C, Olson A, Micheva KD, Wang G, Lemmens R, Tran KV, Nishiyama Y, Liang X, Hamilton SA, O'Rourke N, Smith SJ, Huguenard JR, Bliss TM, Steinberg GK. Enhanced phasic GABA inhibition during the repair phase of stroke: a novel therapeutic target. Brain 2015; 139:468-80. [PMID: 26685158 PMCID: PMC4805083 DOI: 10.1093/brain/awv360] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/20/2015] [Indexed: 11/13/2022] Open
Abstract
Ischaemic stroke is the leading cause of severe long-term disability yet lacks drug therapies that promote the repair phase of recovery. This repair phase of stroke occurs days to months after stroke onset and involves brain remapping and plasticity within the peri-infarct zone. Elucidating mechanisms that promote this plasticity is critical for the development of new therapeutics with a broad treatment window. Inhibiting tonic (extrasynaptic) GABA signalling during the repair phase was reported to enhance functional recovery in mice suggesting that GABA plays an important function in modulating brain repair. While tonic GABA appears to suppress brain repair after stroke, less is known about the role of phasic (synaptic) GABA during the repair phase. We observed an increase in postsynaptic phasic GABA signalling in mice within the peri-infarct cortex specific to layer 5; we found increased numbers of α1 receptor subunit-containing GABAergic synapses detected using array tomography, and an associated increased efficacy of spontaneous and miniature inhibitory postsynaptic currents in pyramidal neurons. Furthermore, we demonstrate that enhancing phasic GABA signalling using zolpidem, a Food and Drug Administration (FDA)-approved GABA-positive allosteric modulator, during the repair phase improved behavioural recovery. These data identify potentiation of phasic GABA signalling as a novel therapeutic strategy, indicate zolpidem’s potential to improve recovery, and underscore the necessity to distinguish the role of tonic and phasic GABA signalling in stroke recovery.
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Affiliation(s)
- Takeshi Hiu
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA 2 Stanford Stroke Centre, Palo Alto, CA 94304, USA
| | - Zoya Farzampour
- 3 Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Jeanne T Paz
- 3 Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA 4 Gladstone Institute of Neurological Disease and University of California, San Francisco San Francisco, CA USA
| | - Eric Hou Jen Wang
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA 2 Stanford Stroke Centre, Palo Alto, CA 94304, USA
| | - Corrine Badgely
- 3 Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Andrew Olson
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Kristina D Micheva
- 5 Department of Molecular and Cellular Physiology, Stanford University, Stanford, CA, USA
| | - Gordon Wang
- 5 Department of Molecular and Cellular Physiology, Stanford University, Stanford, CA, USA
| | - Robin Lemmens
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA 2 Stanford Stroke Centre, Palo Alto, CA 94304, USA 6 KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology; VIB - Vesalius Research Center University Hospitals Leuven, Department of Neurology, B-3000 Leuven, Belgium
| | - Kevin V Tran
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA 2 Stanford Stroke Centre, Palo Alto, CA 94304, USA
| | - Yasuhiro Nishiyama
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA 2 Stanford Stroke Centre, Palo Alto, CA 94304, USA
| | - Xibin Liang
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA 2 Stanford Stroke Centre, Palo Alto, CA 94304, USA
| | - Scott A Hamilton
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA 2 Stanford Stroke Centre, Palo Alto, CA 94304, USA
| | - Nancy O'Rourke
- 5 Department of Molecular and Cellular Physiology, Stanford University, Stanford, CA, USA
| | - Stephen J Smith
- 5 Department of Molecular and Cellular Physiology, Stanford University, Stanford, CA, USA
| | - John R Huguenard
- 3 Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Tonya M Bliss
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA 2 Stanford Stroke Centre, Palo Alto, CA 94304, USA
| | - Gary K Steinberg
- 1 Department of Neurosurgery, Stanford University, Stanford, CA, USA 2 Stanford Stroke Centre, Palo Alto, CA 94304, USA 3 Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
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α2-Adrenergic stimulation of the ventrolateral preoptic nucleus destabilizes the anesthetic state. J Neurosci 2015; 34:16385-96. [PMID: 25471576 DOI: 10.1523/jneurosci.1135-14.2014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The sleep-promoting ventrolateral preoptic nucleus (VLPO) shares reciprocal inhibitory inputs with wake-active neuronal nuclei, including the locus ceruleus. Electrophysiologically, sleep-promoting neurons in the VLPO are directly depolarized by the general anesthetic isoflurane and hyperpolarized by norepinephrine, a wake-promoting neurotransmitter. However, the integration of these competing influences on the VLPO, a sleep- and anesthetic-active structure, has yet to be evaluated in either brain slices in vitro or the intact organism. Single-cell multiplex RT-PCR conducted on both isoflurane-activated, putative sleep-promoting VLPO neurons and neighboring, state-indifferent VLPO neurons in mouse brain slices revealed widespread expression of α2A-, α2B- and α2C-adrenergic receptors in both populations. Indeed, both norepinephrine and the highly selective α2 agonist dexmedetomidine each reversed the VLPO depolarization induced by isoflurane in slices in vitro. When microinjected directly into the VLPO of a mouse lightly anesthetized with isoflurane, dexmedetomidine increased behavioral arousal and reduced the depressant effects of isoflurane on barrel cortex somatosensory-evoked potentials but failed to elicit spectral changes in spontaneous EEG. Based on these observations, we conclude that local modulation of α-adrenergic activity in the VLPO destabilizes, but does not fully antagonize, the anesthetic state, thus priming the brain for anesthetic emergence.
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Abstract
Because of proven efficacy, reduced side effects, and less concern about addiction, non-benzodiazepine receptor agonists (non-BzRA) have become the most commonly prescribed hypnotic agents to treat onset and maintenance insomnia. First-line treatment is cognitive-behavioral therapy. When pharmacologic treatment is indicated, non-BzRA are first-line agents for the short-term and long-term management of transient and chronic insomnia related to adjustment, psychophysiologic, primary, and secondary causation. In this article, the benefits and risks of non-BzRA are reviewed, and the selection of a hypnotic agent is defined, based on efficacy, pharmacologic profile, and adverse events.
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Affiliation(s)
- Philip M Becker
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA; Sleep Medicine Associates of Texas, 5477 Glen Lakes Drive, Suite 100, Dallas, TX 75231, USA.
| | - Manya Somiah
- Sleep Medicine Associates of Texas, 5477 Glen Lakes Drive, Suite 100, Dallas, TX 75231, USA
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Chatelle C, Thibaut A, Gosseries O, Bruno MA, Demertzi A, Bernard C, Hustinx R, Tshibanda L, Bahri MA, Laureys S. Changes in cerebral metabolism in patients with a minimally conscious state responding to zolpidem. Front Hum Neurosci 2014; 8:917. [PMID: 25520636 PMCID: PMC4251320 DOI: 10.3389/fnhum.2014.00917] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/27/2014] [Indexed: 11/30/2022] Open
Abstract
Background: Zolpidem, a short-acting non-benzodiazepine GABA agonist hypnotic, has been shown to induce paradoxical responses in some patients with disorders of consciousness (DOC), leading to recovery of arousal and cognitive abilities. We here assessed zolpidem-induced changes in regional brain metabolism in three patients with known zolpidem response in chronic post-anoxic minimally conscious state (MCS). Methods: [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) and standardized clinical assessments using the Coma Recovery Scale-Revised were performed after administration of 10 mg zolpidem or placebo in a randomized double blind 2-day protocol. PET data preprocessing and comparison with a healthy age-matched control group were performed using statistical parametric mapping (SPM8). Results: Behaviorally, all patients recovered functional communication after administration of zolpidem (i.e., emergence from the MCS). FDG-PET showed increased metabolism in dorsolateral prefrontal and mesiofrontal cortices after zolpidem but not after placebo administration. Conclusion: Our data show a metabolic activation of prefrontal areas, corroborating the proposed mesocircuit hypothesis to explain the paradoxical effect of zolpidem observed in some patients with DOC. It also suggests the key role of the prefrontal cortices in the recovery of functional communication and object use in hypoxic patients with chronic MCS.
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Affiliation(s)
- Camille Chatelle
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège Liège, Belgium ; Neurorehabilitation Lab, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School Boston, MA, USA
| | - Aurore Thibaut
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège Liège, Belgium ; Center for Sleep and Consciousness, and Postle Laboratory, Department of Psychiatry, University of Wisconsin Madison, WI, USA
| | - Marie-Aurélie Bruno
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège Liège, Belgium
| | - Athena Demertzi
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège Liège, Belgium
| | - Claire Bernard
- Nuclear Medicine Department, University Hospital of Liège Liège, Belgium
| | - Roland Hustinx
- Nuclear Medicine Department, University Hospital of Liège Liège, Belgium
| | - Luaba Tshibanda
- Department of Neuroradiology, University Hospital of Liège Liège, Belgium
| | - Mohamed A Bahri
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège Liège, Belgium
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University and University Hospital of Liège Liège, Belgium
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Yang YW, Hsieh TF, Yu CH, Huang YS, Lee CC, Tsai TH. Zolpidem and the risk of Parkinson's disease: a nationwide population-based study. J Psychiatr Res 2014; 58:84-8. [PMID: 25124550 DOI: 10.1016/j.jpsychires.2014.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/30/2014] [Accepted: 07/04/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND This nationwide population-based study investigated the risk of Parkinson's disease (PD) after zolpidem use in patients with sleep disturbance using the National Health Insurance Research Database (NHIRD) in Taiwan. MATERIAL AND METHODS In total, 59,548 adult patients newly diagnosed with sleep disturbance and who used zolpidem were recruited as the study cohort, along with 42,171 subjects who did not use zolpidem as a comparison cohort from 2002 to 2009. Each patient was monitored for 5 years, and those who subsequently had PD were identified. A Cox proportional hazards model was used to compare the risk of PD between the study and comparison cohorts after adjusting for possible confounding risk factors. RESULTS The patients who received zolpidem had a higher cumulative rate of PD than those who did not receive zolpidem during the 5-year follow-up period (1.2% vs. 0.5%, P < 0.001). The adjusted hazard ratios were 1.10 (95% CI, 0.88-1.37), 1.41 (95% CI, 1.17-1.72), and 1.27 (95% CI, 1.05-1.55) for zolpidem use with 28-90, 91-365, and more than 365 cumulative defined daily doses (cDDDs), respectively, compared to those who did not use zolpidem. CONCLUSIONS Among the patients with sleep disturbance, zolpidem use increased the risk of PD after 5 years of follow-up. Further mechanistic research of zolpidem effect in PD is needed.
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Affiliation(s)
- Yu-Wan Yang
- Department of Neurology, China Medical University Hospital and School of Medicine, China Medical University, Taichung, Taiwan
| | - Teng-Fu Hsieh
- Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Chia-Hui Yu
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC
| | - Yung-Sung Huang
- Division of Neurology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC.
| | - Ching-Chih Lee
- School of Medicine, Tzu Chi University, Hualian, Taiwan; Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC; Department of Education, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC.
| | - Tsung-Huang Tsai
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC.
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32
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Hall SD, Prokic EJ, McAllister CJ, Ronnqvist KC, Williams AC, Yamawaki N, Witton C, Woodhall GL, Stanford IM. GABA-mediated changes in inter-hemispheric beta frequency activity in early-stage Parkinson's disease. Neuroscience 2014; 281:68-76. [PMID: 25261686 PMCID: PMC4222199 DOI: 10.1016/j.neuroscience.2014.09.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 12/05/2022]
Abstract
In PD, contralateral M1 showed greater beta power than ipsilateral M1. Zolpidem reduced contralateral beta power while ipsilateral power was increased. This resulted in a hemispheric power ratio that approached parity. Changes were reflected in pre-movement desynchronization and post-movement rebound. These changes underlie the symptomatic improvements afforded by zolpidem.
In Parkinson’s disease (PD), elevated beta (15–35 Hz) power in subcortical motor networks is widely believed to promote aspects of PD symptomatology, moreover, a reduction in beta power and coherence accompanies symptomatic improvement following effective treatment with l-DOPA. Previous studies have reported symptomatic improvements that correlate with changes in cortical network activity following GABAA receptor modulation. In this study we have used whole-head magnetoencephalography to characterize neuronal network activity, at rest and during visually cued finger abductions, in unilaterally symptomatic PD and age-matched control participants. Recordings were then repeated following administration of sub-sedative doses of the hypnotic drug zolpidem (0.05 mg/kg), which binds to the benzodiazepine site of the GABAA receptor. A beamforming based ‘virtual electrode’ approach was used to reconstruct oscillatory power in the primary motor cortex (M1), contralateral and ipsilateral to symptom presentation in PD patients or dominant hand in control participants. In PD patients, contralateral M1 showed significantly greater beta power than ipsilateral M1. Following zolpidem administration contralateral beta power was significantly reduced while ipsilateral beta power was significantly increased resulting in a hemispheric power ratio that approached parity. Furthermore, there was highly significant correlation between hemispheric beta power ratio and Unified Parkinson’s Disease Rating Scale (UPDRS). The changes in contralateral and ipsilateral beta power were reflected in pre-movement beta desynchronization and the late post-movement beta rebound. However, the absolute level of movement-related beta desynchronization was not altered. These results show that low-dose zolpidem not only reduces contralateral beta but also increases ipsilateral beta, while rebalancing the dynamic range of M1 network oscillations between the two hemispheres. These changes appear to underlie the symptomatic improvements afforded by low-dose zolpidem.
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Affiliation(s)
- S D Hall
- Aston Brain Centre, Aston University, Birmingham, West Midlands, UK; School of Psychology, Plymouth University, Devon, UK
| | - E J Prokic
- Aston Brain Centre, Aston University, Birmingham, West Midlands, UK
| | - C J McAllister
- Aston Brain Centre, Aston University, Birmingham, West Midlands, UK
| | - K C Ronnqvist
- Aston Brain Centre, Aston University, Birmingham, West Midlands, UK
| | - A C Williams
- Queen Elizabeth Hospital, University Hospital Birmingham, West Midlands, UK
| | - N Yamawaki
- Aston Brain Centre, Aston University, Birmingham, West Midlands, UK
| | - C Witton
- Aston Brain Centre, Aston University, Birmingham, West Midlands, UK
| | - G L Woodhall
- Aston Brain Centre, Aston University, Birmingham, West Midlands, UK
| | - I M Stanford
- Aston Brain Centre, Aston University, Birmingham, West Midlands, UK.
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Trial of Zolpidem, Eszopiclone, and Other GABA Agonists in a Patient with Progressive Supranuclear Palsy. Case Rep Med 2014; 2014:107064. [PMID: 25371679 PMCID: PMC4209775 DOI: 10.1155/2014/107064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/06/2014] [Indexed: 11/29/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a progressive, debilitating neurodegenerative disease of the Parkinson-plus family of syndromes. Unfortunately, there are no pharmacologic treatments for this condition, as most sufferers of the classic variant respond poorly to Parkinson medications such as levodopa. Zolpidem, a gamma aminobutyric acid (GABA) agonist specific to the α-1 receptor subtype, has been reported to show improvements in symptoms of PSP patients, including motor dysfunction, dysarthria, and ocular disturbances. We observed a 73-year-old woman with a six-year history of PSP, who, upon administration of a single 12.5 mg dose of sustained-release zolpidem, exhibited marked enhancements in speech, facial expressions, and fine motor skills for five hours. These results were reproduced upon subsequent clinic visits. In an effort to find a sustainable medication that maximized these beneficial effects while minimizing side effects and addressing some of her comorbid neuropsychological conditions, a trial of five other GABA receptor agonists was performed with the patient's consent, while she and her caregivers were blinded to the specific medications. She and her caretakers subsequently reported improvements, especially visual, while on eszopiclone, and, to a lesser degree, temazepam and flurazepam.
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Ciurleo R, Bramanti P, Calabrò RS. Pharmacotherapy for disorders of consciousness: are 'awakening' drugs really a possibility? Drugs 2014; 73:1849-62. [PMID: 24170667 DOI: 10.1007/s40265-013-0138-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disorders of consciousness, including the coma state, vegetative state and minimally conscious state, are among the least understood and least curable conditions in modern neurology. Structural or functional injuries may produce impairments in the neuronal circuits (the ascending reticular activating system and thalamocortical loops) responsible for maintaining the wakefulness state and awareness, associated with a change in neurotransmitter concentrations. Pharmacological agents that are able to restore the levels of neurotransmitters and, consequently, neural synaptic plasticity and functional connectivity of consciousness networks, may play an important role as drugs useful in improving the consciousness state. Currently, there is growing interest in the scientific community with regard to pharmacological agents that act on the gamma amino-butyric acid (GABA) system, such as zolpidem and baclofen, and monoamine systems, such as dopaminergic agents and some antidepressants. The purpose of this article is to provide a comprehensive overview of these potential 'awakening' drugs in patients with disorders of consciousness. The possible mechanisms by which these drugs may exert their effects in promoting recovery of consciousness are discussed, highlighting how many findings are often the result of sporadic events rather than prospective controlled trials or implementation of standard treatment guidelines.
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Affiliation(s)
- Rosella Ciurleo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo S.S. 113, C.da Casazza, 98124, Messina, Italy,
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Hlal H, Kettani N, Berhili N, Rammouz I, Aalouane R. [The role of zolpidem in improving catatonic schizophrenia. Case report]. Presse Med 2014; 43:1018-20. [PMID: 24726030 DOI: 10.1016/j.lpm.2013.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 10/09/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- Hayat Hlal
- CHU Hassan II de Fès, service de psychiatrie, université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès 30000, Maroc.
| | - Narjiss Kettani
- CHU Hassan II de Fès, service de psychiatrie, université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès 30000, Maroc
| | - Nabil Berhili
- CHU Hassan II de Fès, service de psychiatrie, université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès 30000, Maroc
| | - Ismail Rammouz
- CHU Hassan II de Fès, service de psychiatrie, université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès 30000, Maroc
| | - Rachid Aalouane
- CHU Hassan II de Fès, service de psychiatrie, université Sidi Mohamed Ben Abdellah, faculté de médecine et de pharmacie de Fès, Fès 30000, Maroc
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Cahana-Amitay D, Albert ML, Oveis A. Psycholinguistics of Aphasia Pharmacotherapy: Asking the Right Questions. APHASIOLOGY 2014; 28:133-154. [PMID: 24489425 PMCID: PMC3904395 DOI: 10.1080/02687038.2013.818099] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Among the obstacles to demonstrating efficacy of pharmacological intervention for aphasia is quantifying patients' responses to treatment in a statistically valid and reliable manner. In many of the review papers on this topic (e.g., Berthier et al., 2011; de Boissezon, Peran, de Boysson, & Démonet, 2007; Small & Llano, 2009), detailed discussions of various methodological problems are highlighted, with some suggestions on how these shortcomings should be addressed. Given this deep understanding of caveats associated with the experimental design of aphasia pharmacotherapy studies (e.g., Berthier et al., 2011), investigations continue to produce inconsistent results. AIM In this review paper we suggest that inclusion of theory-driven linguistic measures in aphasia pharmacotherapy studies would add an important step toward elucidating precise patterns of improvement in language performance resulting from pharmacotherapeutic intervention. MAIN CONTRIBUTION We provide a brief review of the clinical approaches currently used in pharmacotherapy studies of aphasia, which often lack psycholinguistic grounding. We then present ways in which psycholinguistic models can complement this approach, offering a rationale for task selection, and as a result, lead to a better understanding of treatment effects. We then follow with an example of how such an integrative approach can be implemented in studies targeting stress reduction in people with aphasia, via beta-blocking agents, as a means to augment language performance, using the psycholinguistic framework of "linguistic anxiety" outlined in Cahana-Amitay et al, 2011 as our guideline. CONCLUSION We conclude that the incorporation of psycholinguistic models into aphasia pharmacotherapy studies can increase the resolution with which we can identify functional changes.
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Affiliation(s)
- Dalia Cahana-Amitay
- Boston University School of Medicine, Department of Neurology, Harold Goodglass Aphasia Research Center, VA Boston Healthcare System, 150 South Huntington Avenue Boston, MA02130
| | - Martin L Albert
- Boston University School of Medicine, Department of Neurology, Harold Goodglass Aphasia Research Center, VA Boston Healthcare System, 150 South Huntington Avenue Boston, MA02130
| | - Abigail Oveis
- Boston University School of Medicine, Department of Neurology, Harold Goodglass Aphasia Research Center, VA Boston Healthcare System, 150 South Huntington Avenue Boston, MA02130
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Williams ST, Conte MM, Goldfine AM, Noirhomme Q, Gosseries O, Thonnard M, Beattie B, Hersh J, Katz DI, Victor JD, Laureys S, Schiff ND. Common resting brain dynamics indicate a possible mechanism underlying zolpidem response in severe brain injury. eLife 2013; 2:e01157. [PMID: 24252875 PMCID: PMC3833342 DOI: 10.7554/elife.01157] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Zolpidem produces paradoxical recovery of speech, cognitive and motor functions in select subjects with severe brain injury but underlying mechanisms remain unknown. In three diverse patients with known zolpidem responses we identify a distinctive pattern of EEG dynamics that suggests a mechanistic model. In the absence of zolpidem, all subjects show a strong low frequency oscillatory peak ∼6–10 Hz in the EEG power spectrum most prominent over frontocentral regions and with high coherence (∼0.7–0.8) within and between hemispheres. Zolpidem administration sharply reduces EEG power and coherence at these low frequencies. The ∼6–10 Hz activity is proposed to arise from intrinsic membrane properties of pyramidal neurons that are passively entrained across the cortex by locally-generated spontaneous activity. Activation by zolpidem is proposed to arise from a combination of initial direct drug effects on cortical, striatal, and thalamic populations and further activation of underactive brain regions induced by restoration of cognitively-mediated behaviors. DOI:http://dx.doi.org/10.7554/eLife.01157.001 Some individuals who experience severe brain damage are left with disorders of consciousness. While they can appear to be awake, these individuals lack awareness of their surroundings and cannot respond to events going on around them. Few treatments are available, but a minority of patients show striking improvements in speech, alertness and movement in response to the sleeping pill zolpidem. Although the idea of a sleeping pill increasing consciousness is paradoxical, it is possible that in patients with impaired consciousness, zolpidem reduces the activity of an area of the brain that would otherwise inhibit activity in other regions of the brain. However, the precise mechanisms by which zolpidem increases consciousness in these patients, and the reasons why only a minority of individuals respond, are unknown. Now, Williams et al. have used electrodes attached to the scalp to measure changes in brain activity in three patients known to respond to zolpidem. These measurements showed that before the drug was taken, there were two important differences between the brain activity of the patients and that of healthy subjects: first, the patients showed brain waves of a lower frequency than any seen in healthy subjects; second, these brain waves were much more synchronized than brain activity in healthy individuals. After taking zolpidem, this synchronicity was reduced and all of the patients also showed an increase in higher frequency brain waves. Based on the effects of zolpidem on electrical activity throughout the brain, Williams et al. propose a new model to explain the therapeutic action of the drug in some minimally conscious patients. If the correlation between brain waves and zolpidem response holds up in future studies, this relation could be used to predict which patients might benefit from the drug. A better understanding of these processes should also help us to understand, diagnose and develop new treatments for disorders of consciousness. DOI:http://dx.doi.org/10.7554/eLife.01157.002
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Affiliation(s)
- Shawniqua T Williams
- Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, United States
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Isomura S, Monji A, Sasaki K, Baba S, Onitsuka T, Ohara T, Mizoguchi Y, Kato TA, Horikawa H, Seki Y, Kanba S. FTD with catatonia-like signs that temporarily resolved with zolpidem. Neurol Clin Pract 2013; 3:354-357. [PMID: 29473615 DOI: 10.1212/cpj.0b013e318296f263] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Shuichi Isomura
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Akira Monji
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Kensuke Sasaki
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Shingo Baba
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Toshiaki Onitsuka
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Tomoyuki Ohara
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshito Mizoguchi
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Takahiro A Kato
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Hideki Horikawa
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshihiro Seki
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
| | - Shigenobu Kanba
- Departments of Neuropsychiatry (SI, KS, T. Onitsuka, T. Ohara, TAK, HH, YS, SK) and Clinical Radiology (SB), Graduate School of Medical Sciences, Kyushu University, Fukuoka; and Department of Psychiatry (AM, YM), Faculty of Medicine, Saga University, Saga, Japan
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Chang CC, Wang WF. High-dose zolpidem withdrawal seizure in a patient with spinocerebellar ataxia. Prim Care Companion CNS Disord 2013; 13:10l01114. [PMID: 21977371 DOI: 10.4088/pcc.10l01114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Cheng-Chen Chang
- Department of Psychiatry, Changhua Christian Hospital, Changhua City, Taiwan
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Autret K, Arnould A, Mathieu S, Azouvi P. Transient improvement of poststroke apathy with zolpidem: a single-case, placebo-controlled double-blind study. BMJ Case Rep 2013; 2013:bcr-2012-007816. [PMID: 23396925 DOI: 10.1136/bcr-2012-007816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 44-year-old patient with severe and disabling apathy nearly 2 years after a right hemisphere haemorrhagic stroke. The effect of a single dose of zolpidem was tested over a 2-week period, in alternation with either no treatment or a placebo in a double-blind randomised trial. Zolpidem was associated with a dramatic improvement in apathy, as assessed with the Apathy Inventory and the Behavioral Dysexecutive Syndrome Inventory. No adverse effect occurred during the trial.
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43
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Perisynaptic GABA Receptors The Overzealous Protector. Adv Pharmacol Sci 2012; 2012:708428. [PMID: 22461789 PMCID: PMC3296136 DOI: 10.1155/2012/708428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 12/12/2011] [Indexed: 12/22/2022] Open
Abstract
An attempt to find pharmacological therapies to treat stroke patients and minimize the extent of cell death has seen the failure of dozens of clinical trials. As a result, stroke/cerebral ischemia is the leading cause of lasting adult disability. Stroke-induced cell death occurs due to an excess release of glutamate. As a consequence to this, a compensatory increased release of GABA occurs that results in the subsequent internalization of synaptic GABA(A) receptors and spillover onto perisynaptic GABA(A) receptors, resulting in increased tonic inhibition. Recent studies show that the brain can engage in a limited process of neural repair after stroke. Changes in cortical sensory and motor maps and alterations in axonal structure are dependent on patterned neuronal activity. It has been assumed that changes in neuronal excitability underlie processes of neural repair and remapping of cortical sensory and motor representations. Indeed, recent evidence suggests that local inhibitory and excitatory currents are altered after stroke and modulation of these networks to enhance excitability during the repair phase can facilitate functional recovery after stroke. More specifically, dampening tonic GABA inhibition can afford an early and robust improvement in functional recovery after stroke.
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Drug Therapy of Post-Stroke Aphasia: A Review of Current Evidence. Neuropsychol Rev 2011; 21:302-17. [DOI: 10.1007/s11065-011-9177-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/27/2011] [Indexed: 11/26/2022]
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Licata SC, Lowen SB, Trksak GH, MacLean RR, Lukas SE. Zolpidem reduces the blood oxygen level-dependent signal during visual system stimulation. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1645-52. [PMID: 21640782 PMCID: PMC3154455 DOI: 10.1016/j.pnpbp.2011.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/07/2011] [Accepted: 05/23/2011] [Indexed: 11/30/2022]
Abstract
Zolpidem is a short-acting imidazopyridine hypnotic that binds at the benzodiazepine binding site on specific GABA(A) receptors to enhance fast inhibitory neurotransmission. The behavioral and receptor pharmacology of zolpidem has been studied extensively, but little is known about its neuronal substrates in vivo. In the present within-subject, double-blind, and placebo-controlled study, blood oxygen level-dependent functional magnetic resonance imaging (BOLD fMRI) at 3 Tesla was used to assess the effects of zolpidem within the brain. Healthy participants (n=12) were scanned 60 min after acute oral administration of zolpidem (0, 5, 10, or 20mg), and changes in BOLD signal were measured in the visual cortex during presentation of a flashing checkerboard. Heart rate and oxygen saturation were monitored continuously throughout the session. Zolpidem (10 and 20mg) reduced the robust visual system activation produced by presentation of this stimulus, but had no effects on physiological activity during the fMRI scan. Zolpidem's modulation of the BOLD signal within the visual cortex is consistent with the abundant distribution of GABA(A) receptors localized in this region, as well as previous studies showing a relationship between increased GABA-mediated neuronal inhibition and a reduction in BOLD activation.
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Affiliation(s)
- Stephanie C. Licata
- Behavioral Psychopharmacology Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont MA, 02478, USA
| | - Steven B. Lowen
- Behavioral Psychopharmacology Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont MA, 02478, USA, Brain Imaging Center, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont MA, 02478, USA
| | - George H. Trksak
- Behavioral Psychopharmacology Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont MA, 02478, USA, Sleep Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont MA, 02478, USA
| | - Robert R. MacLean
- Behavioral Psychopharmacology Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont MA, 02478, USA
| | - Scott E. Lukas
- Behavioral Psychopharmacology Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont MA, 02478, USA, Brain Imaging Center, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont MA, 02478, USA, Sleep Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont MA, 02478, USA
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Clauss RP. Neurotransmitters in disorders of consciousness and brain damage. Med Hypotheses 2011; 77:209-13. [PMID: 21549512 DOI: 10.1016/j.mehy.2011.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/30/2011] [Accepted: 04/08/2011] [Indexed: 01/17/2023]
Abstract
Restorations from disorders of consciousness such as the minimally conscious state and the vegetative state have been achieved spontaneously or by pharmacological agents such as zolpidem, baclofen, dopaminergic agents and tricyclic antidepressants in some patients. Other restoration methods have included electric and magnetic nerve stimulation, oxygen, Kreb's cycle constituent substitution and axonal re-growth. Although apparently unrelated, these methods all influence neurotransmitter availability or production within the brain. This review proposes depleted neurotransmitter function as a cause for long term brain suppression and disorders of consciousness. It unifies fundamentally different treatment approaches and explores the restoration of neurotransmitter function as a common theme to improve brain function after brain damage.
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Affiliation(s)
- R P Clauss
- Nuclear Medicine Department, Royal Surrey County Hospital, Guildford, Surrey GU27XX, UK.
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Güngör L, Terzi M, Onar MK. Does long term use of piracetam improve speech disturbances due to ischemic cerebrovascular diseases? BRAIN AND LANGUAGE 2011; 117:23-27. [PMID: 21227483 DOI: 10.1016/j.bandl.2010.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/27/2010] [Accepted: 11/25/2010] [Indexed: 05/30/2023]
Abstract
Aphasia causes significant disability and handicap among stroke survivors. Language therapy is recommended for aphasic patients, but not always available. Piracetam, an old drug with novel properties, has been shown to have mild beneficial effects on post-stroke aphasia. In the current study, we investigated the effects of 6 months treatment with piracetam on aphasia following stroke. Thirty patients with first-ever ischemic strokes and related aphasia were enrolled in the study. The scores for the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale (mRS), and Gülhane Aphasia Test were recorded. The patients were scheduled randomly to receive either 4.8 g piracetam daily or placebo treatment for 6 months. At the end of 24 weeks, clinical assessments and aphasia tests were repeated. The level of improvement in the clinical parameters and aphasia scores was compared between the two groups. All patients had large lesions and severe aphasia. No significant difference was observed between the piracetam and placebo groups regarding the improvements in the NIHSS, BI and mRS scores at the end of the treatment. The improvements observed in spontaneous speech, reading fluency, auditory comprehension, reading comprehension, repetition, and naming were not significantly different in the piracetam and placebo groups, the difference reached significance only for auditory comprehension in favor of piracetam at the end of the treatment. Piracetam is well-tolerated in patients with post-stroke aphasia. Piracetam taken orally in a daily dose of 4.8 g for 6 months has no clear beneficial effect on post-stroke language disorders.
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Affiliation(s)
- Levent Güngör
- Department of Neurology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey.
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Clauss R. Neurotransmitters in Coma, Vegetative and Minimally Conscious States, pharmacological interventions. Med Hypotheses 2010; 75:287-90. [DOI: 10.1016/j.mehy.2010.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 03/06/2010] [Indexed: 12/25/2022]
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Pistoia F, Mura E, Govoni S, Fini M, Sarà M. Awakenings and awareness recovery in disorders of consciousness: is there a role for drugs? CNS Drugs 2010; 24:625-38. [PMID: 20658796 DOI: 10.2165/11535940-000000000-00000] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Disorders of consciousness (DOC) include coma, vegetative state (VS) and minimally conscious state (MCS). Coma is a condition of unarousability with a complete absence of wakefulness and awareness, whereas VS is characterized by a lack of awareness despite a preserved wakefulness. Patients in coma are unconscious because they lack both wakefulness and awareness. Patients in a VS are unconscious because, although they are wakeful, they lack awareness. Patients in a MCS show minimal but definite behavioural evidence of self and environmental awareness. Coma results from diffuse bilateral hemispheric lesions or selective damage to the ascending reticular system (which is functionally connected to the cerebral cortex by intralaminar thalamic nuclei). VS is a syndrome that is considered to be the result of a disconnection of different cortical networks rather than a dysfunction of a single area or a global reduction in cortical metabolism. As revealed by functional imaging studies, clinical recovery is often associated with a functional restoration of cortico-thalamo-cortical connections. Depending on the amount of network restored, patients may regain full consciousness or remain in a MCS. Molecular and neural mediators may indirectly contribute to the above restoration processes owing to their role in the phenomenon of neural synaptic plasticity. Therefore, there is growing interest in the possible effects of drugs that act at the level of the CNS in promoting emergence from DOC. Sporadic cases of dramatic recovery from DOC after the administration of various pharmacological agents, such as baclofen, zolpidem and amantadine, have been recently supported by intriguing scientific observations. Analysis of the reported cases of recovery, with particular attention paid to the condition of the patients and to the association of their improvement with the start of drug administration, suggests that these treatments might have promoted the clinical improvement of some patients. These drugs are from various and diverging classes, but can be grouped into two main categories, CNS stimulants and CNS depressants. Some of these treatments seem to directly encourage a consciousness restoration, while others play a more determinant role in improving cognitive domains, especially in patients with residual cognitive impairment, than in the field of consciousness. Given the great interest recently generated in the scientific community by the increasing number of papers addressing this issue, further investigation of the above treatments, with particular attention paid to their mechanisms of action, the neurotransmitters involved and their effects on cortico-thalamo-cortical circuitry, is needed.
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