Zolpidem abuse/dependence/withdrawal
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Paroxysmal tonic spasm following drug withdrawal: case report A 21-year-old man developed paroxysmal tonic spasm (PTS) following abrupt withdrawal of zolpidem. Additionally, he also developed dependence on zolpidem due to constant consumption of zolpidem in supra-therapeutic doses for a long time (abuse). The man, who had psychiatric disorder and insomnia from last 3 years, was admitted due to acute onset of attacks or episodic involuntary and painful movements of all the extremities and neck. These symptom had been started one day before the admission. The episode lasted less than 2 minutes and repeatedly occurred 10–15 times a day. It was also reported that, he remained conscious and aware during the episodes or attacks. The episodes were described as abnormal movements, which were in dystonic form with neck and head turned to the right, shoulder adduction and internal rotation, extension and stretching of upper and lower limbs along with sparing of face and trunk. The involvement of his limbs was bilateral and simultaneous. He was able to speak at the time of the attacks; however, was unable to move until the attack had completely stopped. There was a rapid improvement in the muscle contraction was present. He had tachycardia, diaphoresis and increased respiration during the attacks, although he remained normal between the attacks. The symptoms were noted on awakening and did not change during the physical examination and observation. Interictal EEG, and unspecified imaging were found to be normal. It was also revealed that, he had been receiving oral zolpidem 10mg daily for psychiatric disorder for the past one year. After initiation of zolpidem, his anxiety and restlessness decreased. After 2 months, he gradually increased his daily zolpidem consumption to 70–80mg daily (supra-therapeutic dose). After 6 months, he abruptly stopped taking zolpidem due to nightmares and dizziness [aetiology of nightmares and dizziness not stated]. Approximately 24 hours following withdrawal of zolpidem, he started having episodes of abnormal movements. At the time of current admission, he was found to be agitated, and his psychomotor activity was found to be increased. Investigations showed the following: pulse rate 90, respiratory rate 20, BP 130/70 [units not stated], oxygen saturation 98% and body temperature 36.8°C. Based on the investigations, he was diagnosed with PTS secondary to abrupt zolpidem withdrawal. Additionally, development of zolpidem dependence due to zolpidem abuse (constant consumption of zolpidem in supra-therapeutic doses for a long time) was also determined. The man was treated with diazepam and zolpidem, which was tapered gradually over one week. Eventually, his symptoms improved. He was discharged on zolpidem and followed up for 8 months. Four weeks later, zolpidem was discontinued. After 8 months of follow-up, he was found to be asymptomatic, and no tonic attacks were reported. Keighobadi M, et al. Paroxysmal tonic spasm in a patient with the sudden zolpidem withdrawal: A case report. Clinical Neur
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