According to findings from a new systematic review, the insomnia drug zolpidem appears to impart significant yet transient effects on patients with non-insomnia neurologic disorders, particularly those with movement disorders and disorders of consciousness. The study is available online in JAMA Neurology.

To better understand this unique effect of zolpidem tartrate, researchers from the University of Michigan, Ann Arbor, MI, reviewed studies of zolpidem used to treat neurologic disorders across various databases. A total of 2,314 articles were identified, of which 67 were included for the final review: 31 studies on movement disorders, 22 on disorders of consciousness, and 14 on other neurologic conditions (eg, stroke, traumatic brain injury, encephalopathy, dementia). 

Among patients treated with zolpidem, progress was reported in coma recovery, dystonia, Parkinson’s disease, and other motor, auditory, and verbal skills, as measured by the following scales: JFK Coma Recovery Scale-Revised, Unified Parkinson Disease Rating Scale, and the Burke-Fahn Marsden Dystonia Rating Scale. “Some patients improved to a minimally conscious state while others even tried to speak to their loved ones, for perhaps the first time in years. Some patients’ functional neuroimaging results improved as well,” the authors noted.  

Improvements lasted about 1–4 hours before returning to baseline. The most common adverse effect was sedation, which was seen in 13 of the 551 evaluated patients.

“This is one of those strange paradoxes where the effects of an insomnia drug seem to have the opposite effect for patients who have paralysis or neurologic conditions,” stated co-author Mark Peterson, PhD, MS, FACSM. The overall findings from the review support zolpidem as a potential new treatment mechanism for these neurologic disorders, according to the authors. 

Since the preliminary findings come mostly from case reports and small interventional trials, more research is needed to better understand safety and effectiveness in this patient population.

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