Clinical and imaging evidence of zolpidem effect in hypoxic encephalopathy

We conducted a randomized, double-blind, placebo-controlled, single-patient (N = 1) trial to evaluate the efficacy of zolpidem in a 48-year-old woman with an akinetic mutism. Motor and cognitive examinations and functional imaging were performed. Acute administration of zolpidem markedly improved motor performance and neuropsychological status. Cerebral metabolism (F-18-fluorodeoxyglucose positron emission tomography) increased in postrolandic territories and in frontal cortex. Using the (H2O)-O-15 positron emission tomography, we found a drug-induced activation in the anterior cingulate and orbitoftontal cortices. Zolpidem induced a transient improvement in motor and cognitive performances. This paradoxical effect could result from an activation of limbic loops modulating motivational processes.