A man whose brain injury left him unable to walk or talk for eight years regained full consciousness 20 minutes after taking the sleeping pill Ambien.
The 39-year-old from Amsterdam – referred to only as Richard in the medical journal Cortex – was diagnosed with akinetic mutism at age 29. He suffered the rare mental disorder after choking on a piece of meat, which starved his brain of oxygen and robbed him of his ability to perform basic tasks.
Richard was only able to respond to questions or commands by making gestures with his eyes, but did not move voluntarily and had to be fed through a tube.
Doctors said they decided to give him zolpidem – sold in the UK as Stilnoct, and in the US as Ambien – as a last resort, following reports of the sleeping pill temporarily curing patients of paralysis in studies around the world.
Within 20 minutes Richard was able to walk with the help of his carers and phone his father, who had not heard his son’s voice in nearly a decade.
Writing in the journal, medics said giving Richard the drug once a day could keep him alert for two hours. But the medication would start to lose its impact if taken for five days on the trot because his body would become tolerant of it.
Akinetic mutism does not physically paralyse people, but it slows their mental function down so much that the brain struggles to send signals to the body to move, talk or eat. Researchers believe Ambien helps reopen these pathways.
A 39-year-old patients from the Netherlands – referred to only as Richard (right) in medical journal Cortex – was diagnosed with akinetic mutism at age 29. He suffered the rare mental disorder after choking on a piece of meat, which starved his brain of oxygen
Ambien is one of the most commonly prescribed in the US, outselling painkillers such as Percocet and maximum strength ibuprofen
Willemijn van Erp, a doctoral student at Radboud University, was training to become a doctor in elderly care when she met Richard at a specialised nursing home.
She said Richard’s family agreed to administer Ambien because his situation ‘seemed hopeless’ and no other medications had any effect.
Within 20 minutes, Richard had asked his nurse how to operate his wheelchair, walked assisted by his carers, requested fast food and phoned his father.
The drug’s effects lasted about two hours before he would slip back out of consciousness.
His medical team have had to become selective about when they medicate Richard because his body starts to become tolerant of the drug after five days.
They said: ‘On average, it would require two to three medication-free weeks to notice the effects of a single dose of zolpidem again. Consequently, administration was restricted to special occasions.’
Scans show, following his accident in 2012, parts of Richard’s brain appear to shut down because of sensory overload whenever he tries to perform a basic task.
Hisse Arnts, a researcher from Amsterdam University Medical Centre who has been caring for Richard, said:’You could compare the brain, as it were, to a large string orchestra.
‘With Richard, 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 back within time.
‘Administering this sleeping medication can suppress this unwanted brain overactivity, creating space for speech and movement.’
Previous studies have indicated that about one in 20 patients with consciousness disorders given Ambien see their condition improve, at least temporarily. The Dutch researchers are looking into a long-lasting solution.
Akinetic mutism has been spotted in people who’ve suffered brain trauma, as well as in stroke, cancer and tumour patients.
It is classed as a consciousness disorder, a term which also includes people in comas, or in vegetative states.
Patients with the rare condition are unresponsive to commands or questions but appear awake and normally communicate through eye movement.
The first patient, a 14-year-old girl from England, was diagnosed with the rare condition in 1941.
It was named after the medical terms for people tending neither to move (akinesia) nor speak (mutism).
Treatment options are limited. In some cases, the removal of a tumour or cyst in the brain can relieve symptoms almost immediately.
For others, whose disorder has been triggered by an injury or stroke – doctors may use intravenous magnesium sulfate.
The naturally-occurring mineral can revive brain cells that have died or become too damaged to function.
Medics may also prescribe anti-depressants, or stimulant drugs to try and jump-start the brain’s pathways.
Patients who recover say when they tried to attempt a movement or gesture, it was as though their body put up a ‘resistance’ that makes it to difficult to perform.
Ambien is one of the most commonly prescribed in the US, outselling painkillers such as Percocet and maximum strength ibuprofen, with doctors writing prescriptions for about 15million Americans every year.
An estimated 6million Britons are prescribed Stilnoct, the brand name of the sleeping pill in the UK.
They are used to treat insomnia and helps people fall asleep more quickly and makes them less likely to wake up in the middle of the night.
The most common side effects of taking Ambien and Stilnoct are drowsiness and dizziness.
Some patients have reported ‘blackouts’ after taking high doses of the drug, where they can’t remember their actions for hours on end.
Source: Daily Mail
