Postoperative Treatment of Intracranial Hypotension Venous Congestion-Associated Brain Injury With Zolpidem.
Lauren M Desmarais, Kristen A Milleville, Amy K Wagner
PMID 32932357WHAT IT FOUND
One patient with a postoperative brain injury from low spinal fluid pressure was more alert and oriented after zolpidem doses and later inpatient rehabilitation.
This describes one person, not proof zolpidem caused recovery.
Key findings
01After the first 2.5 mg bedtime dose, the patient was re-examined 12 hours later and could sit at the edge of the bed without assistance, visually track, give accurate yes/no answers, and follow simple commands.
02After three doses, the patient was oriented to self, place, and year, had insight into his hospital admission, and could recite the months of the year backwards.
03Over a 9-day inpatient rehabilitation stay, the patient's Functional Independence Measure score improved from 71 to 88 on an 18-category scale where each category is rated 1 to 7 and higher means more independence.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
It is a single case report, so it cannot show that zolpidem caused improvement. There was no comparison group, so the observed changes cannot be attributed to any single treatment. The patient also received inpatient rehabilitation, so the paper cannot separate zolpidem's contribution from rehabilitation. The amount of CSF loss before dural repair was not documented. Follow-up was a telephone report about cognition back to baseline, not a formal assessment. The authors had prior experience with zolpidem in similar cases, which may have influenced the decision to try it.
Declared interests
The authors declared no competing interests and no financial benefits.
The easy way to misread this
Do not read this as evidence that zolpidem treats intracranial hypotension brain injury. It describes one patient who received zolpidem and inpatient rehabilitation, and the paper does not show how much of the improvement came from each.