Sleeping Pill Wakes Patient From a Locked-in State

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A case study published in the journal Cortex reported the miraculous case of a 37-year-old awakened from a state of mutism after an experimental treatment with Zolpidem, a common sleeping pill.

Eight years ago, Richard suffered from a brain injury after choking on a piece of meat. The brain injury occurred as a result of severe oxygen deprivation.

Although he had an initial but slow neurological recovery, he soon lost the ability to move or talk. He even lost the ability to eat independently and required an enteral feeding tube. 

However, he appeared to be awake and conscious.

Eventually, Richard became wheelchair-bound and fully dependent on his nursing staff for all his daily activities. Dr. Hisse Arnts, the lead author of the study and neurosurgical resident at Amsterdam UMC, classified Richard as having Akinetic Mutism. 

These patients have an intact level of consciousness but present with the inability to speak or move spontaneously. The patient constantly is in a wakeful state of profound apathy, seemingly indifferent to pain, thirst, hunger, and shows no emotions.

Dr. Hisse Arnts (lead study author)

Experimenting with Sleeping Pills

Richard remained in this hyporesponsive state for eight years. That is, until Willemijn van Erp, a specialist in elderly care, suggested an experimental treatment usually reserved for patients suffering from disorders of consciousness. 

A single 10mg dose of Zolpidem, a common sleeping pill, was given to the patient. Within 20 minutes of receiving the drug, Richard started to talk spontaneously, requesting the doctor for a burger. He even managed to walk a short distance while taking support from the staff and gave a call to his father who hadn’t heard his voice in years.

A video of Richard before and after receiving Zolpidem.
Source: 10.17632/d8jncnwjx7.2#file-e5a3246a-21f7-4b22-b787-112c7ee301e0

Two hours later, the effects wore off and Richard went back to his ‘locked-in’ state. Doctors then began administering a daily regimen of three doses of zolpidem. However, they noted the effectiveness of the drug greatly reduced after being used for several consecutive days.

The team of researchers, therefore, aimed to investigate the drug’s effect on Richard’s brain by conducting scans and tests before and after the administration of the drug. 

If you could compare the function of the brain, as it were, to a large string orchestra. In our patient, the first violins play so loud that they drown out the other members of the string orchestra and people can no longer hear each other. Zolpidem ensures that these first violins play more ‘pianissimo,’ so that everyone plays back within time

Dr. Hisse Arnts (lead study author)

The team of researchers found overactivity in certain parts of Richard’s brain. They discovered Zolpidem suppressed this unwanted overactivity thus, creating space for speech and movement.

In conclusion, the authors of the study suggest further research be conducted to fully understand the neurological manifestation of severe brain injury in the hopes to discover new treatments. 

Reference:

Arnts, Hisse, et al. “Awakening after a Sleeping Pill: Restoring Functional Brain Networks after Severe Brain Injury.” Cortex, vol. 132, 2020, pp. 135–146., doi:10.1016/j.cortex.2020.08.011

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