Zolpidem
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Partial epileptic seizure as a paradoxical reaction: case report A 26-year-old woman developed paradoxical partial epileptic seizure following the administration of zolpidem for vegetative state/with unresponsive wakefulness syndrome (VS/UWS). The woman experienced cerebral vasculitis of unclear aetiology accompanied with the development of a diffuse ischemic stroke in the middle cerebral artery territory at the age of 15 years (year 2008). She presented with symptoms that developed acutely with disorder of consciousness to the level of sopor and appearance of right side hemiplegia. After that, her condition aggravated and included disorder of consciousness to the level of coma due to the formation of a haematoma in the right frontal-temporal region. The cause of hemorrhage was arteriovenous malformation of the right hemisphere of the brain. Later, she emerged from coma into VS/UWS. Additionally, she was diagnosed with dyslipidemia of type II. She was then transferred to a neurosurgery research institute of a different hospital. After that, she was followed up at the same neurosurgery research institute (till the most recent follow up examination in 2019). Until 2015, she met the criteria of VS/UWS diagnosis with consciousness according to revised coma recovery scale (CRS-R) score of 3. During examinations in 2019 (at the same institute), signs of minimally conscious state were identified and the CRS-R score was noted as 9. Thereafter, based on previous reports of ’Waking’ effect in some patients with VS/UWS with zolpidem as a paradoxical effect, a trial was scheduled. For the zolpidem test, 10mg of zolpidem was injected into gastrostone [route not stated]. However, 20 minutes after the injection, she developed partial epileptic seizure manifested as chaotic motions, muscle tone growth, agitation and shivering including gaze turn to the left, hemifacial rhythmic contraction of mimic muscles on the right. The seizure lasted for approximately 5 seconds with the generalised increase of muscle tone persisting for ten more minutes. Her mother (who had always been with her) reported that she (her daughter) was more active on that day, she was awake for longer duration and she was able to fix her gaze on objects clearer and for longer duration. In order to confirm relation between the action of zolpidem and development of the epileptic seizure, zolpidem test was repeated on the following day with CRS-R scale (baseline score 9). During the repeat test, she again developed an identical partial epileptic seizure [outcome not stated]. The development of partial epileptic seizures was considered as a paradoxical reaction. Author comment: "Patient K., 26 years of age, responded paradoxically to Zolpidem by developing a convulsive seizure. The relation between the seizure and administration of Zolpidem was confirmed by repeated administration of the drug." Kondratyeva EA, et al. Zolpidem action during prolonged disorders of consciousness (Case report). Obshchaya Reanimatologiya 15: 44-60, No. 5, Jan 2019. Available from: U
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