Disclosures: Emily Ryan-Michailidis, DO: Nothing to disclose

Case Description: 22-year-old male experienced cardiac arrest secondary to status asthmaticus. Brain MRI showed evidence of sequela of hypoxic ischemic injury including thalami swelling and corpus callosum infarct. Patient was stabilized and admitted to inpatient rehabilitation, at which time patient was in a minimally conscious state with Glasgow Coma Scale score 10, inconsistently moved extremities, nonverbal, and intermittently followed some very simple commands. Patient met DSM-V criteria for catatonia exhibiting features of stupor, rigidity, posturing, mutism, stereotypies and dysautonomia. Patient was started on zolpidem to target catatonic features (CF).

Setting: Inpatient rehabilitation

Patient: 22-year-old with anoxic encephalopathy.

Assessment/Results: Patient was given a single dose of zolpidem 5mg. Prior to dose patient was nonverbal, only withdrew extremities to noxious stimuli, opened/closed eyes to command, and otherwise was not interactive. 1 hour after zolpidem dose, patient attempted to get out of bed, showed spontaneous motor movements, and tracked objects on command. Zolpidem was slowly titrated up to 10mg over days, and patient showed progressive improvement including ability to speak and consistent command following. The CF diminished over time, with initial Bush-Francis catatonia rating scale score of 28 which later improved to 2.

Discussion: In approximately 5% of persons with disorders of consciousness (DOC) zolpidem temporarily improves consciousness through its action as a selective gamma-aminobutyric acid A (GABA-A) agonist. In a 3-case series the CF of posturing, rigidity, and dysautonomia distinguished the GABA-A agonist responders from the non-responders; this case supports this observation as our patient demonstrated these features. It is notable that this patient had cumulative benefit with daily dosing, with behavioral improvement beyond typical therapeutic window of the drug in patients with DOC (3-4h) which has not been reported in other cases.

Conclusion: Evaluation of patients with DOC for specific CF may enhance identification of zolpidem responders, leading to gains in therapy and overall patient function.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/certain-catatonic-features-in-disorders-of-consciousness-may-predict-response-to-zolpidem-a-case-report-in-an-anoxic-brain-injury-patient/