[lit-ideas] Now THIS is interesting!
- From: JimKandJulieB@xxxxxxx
- To: lit-ideas@xxxxxxxxxxxxx
- Date: Sat, 3 Jun 2006 12:11:17 EDT
http://www.newscientist.com/article/dn9215?DCMP=NLC-nletter&nsref=dn9215
Sleeping pill may rouse coma patients
12:39 24 May 2006
NewScientist.com news service
Roxanne Khamsi
A drug used to treat insomnia has paradoxically helped temporarily rouse
three men who were each in a vegetative state following motor accidents,
researchers claim. They believe that zolpidem (marketed as Ambien) activates
dormant
cells in the brain.
But experts caution that the patients may not have been in a permanent
vegetative state (PVS), and that the men may simply have shown signs of
natural
recovery.
The initial discovery that zolpidem could benefit patients of severe brain
trauma came about accidentally, according to Ralf Clauss, who led the study at
the Royal Surrey County Hospital in Guildford, UK. He and colleagues
reported in 2000 that the drug seemed to help restore partial consciousness,
at
least temporarily.
Their new study details the effects of the drug in three patients, all of
whom have been in a PVS for at least three years. People in this state may
have
regular sleep cycles but do not show detectable awareness. The men received
daily doses of zolpidem for up to 6 years.
Before treatment with the drug, Patient L did not respond to any commands
and showed no signs of language comprehension. According to Clauss, after
taking his first, 10 milligram dose of zolpidem the patient could meaningfully
interact with family, friends and strangers. He could name his favourite rugby
player and make simple calculations.
The effects of the drug seemed to last for approximately 4 hours, after
which Patient L would relapse into the vegetative state.
Patient N, who had been in a vegetative state for three years following a
motor vehicle accident, showed no signs of language comprehension and was
constantly screaming. With the drug he stopped screaming and appeared to react
appropriately to scenes on television, laughing at funny moments.
Before taking zolpidem, Patient N scored 6 out of a possible 15 points on
the Glasgow Coma Scale, a measure of responsiveness. With the medication, his
score improved to 10. A coma score of 13 or higher correlates with mild brain
injury while a score of 8 or less is generally considered severe brain injury.
The third man, Patient G, showed no response to language prior to drug
treatment but could count to five after receiving the medication, the
researchers
write. His score on the Glasgow Coma Scale improved temporarily from 9 to 14
points.
All three patients have received daily doses of the drug since the study
began.
Clauss and his colleagues have applied for a usage patent of zolpidem in
brain damage. He says that drugs such as zolpidem, manufactured by
Sanofi-Aventis, activate receptors for the neurotransmitter gamma aminobutyric
acid (GABA)
in the brain.
According to the researchers, brain injury may alter GABA receptors, causing
regions of the brain to remain dormant. They speculate that zolpidem could
possibly, temporarily, reverse this change.
Other experts stress, however, that people are sometimes misdiagnosed as
being in a permanent vegetative state. Mike Barnes, professor of neurological
rehabilitation at the Hunters Moor centre in Newcastle, told the BBC: "A
diagnosis of PVS means the patient should not wake up and respond."
An article published in the British Medical Journal in 1996 (vol 313, p 13)
found that 43% of 40 patients were considered misdiagnosed with the
condition. Only 13% of the patients remained vegetative, the study reported.
Journal reference: NeuroRehabilitation (vol 21, p 23)
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