Disclosures: Suzan O. Lisenby, MD: No financial relationships or conflicts of interest

Case Description: The patient was given traditional neurostimulants including methylphenidate to 15mg twice daily and modafinil 400mg once daily without demonstrable improvement in arousal. Zolpidem 5mg was trialed without desired effect. Subsequently, zolpidem 10mg was given with noted improved arousal and participation in therapy. Zolpidem 10 mg twice daily at 0800 and 1200 was given. His functional improvements included: ability to shake/nod and utilize low-tech eye gaze frame to answer simple yes/no questions; improvement in motor control of non-affected extremities, neck, and face; consistent social participation that improved his ability to self-advocate and express personal needs.

Setting: Inpatient rehabilitation unit

Patient: 32 year old male with pilocytic astrocytoma involving the midbrain, pons, medulla, basal ganglia with resultant hypersomnolence, spastic left hemiparesis Assessment/

Results: Following initiation of zolpidem, the patient began to have improved arousal and alertness. His therapists noted improved ability to communicate including use of an eye gaze system. Additionally, the patient demonstrated more intentional movements with notably improved motor control of his extremities and head. Further functional progress will be discussed.

Discussion: This is the first reported case, to our knowledge, of the use of zolpidem in hypersomnolence due to brainstem tumor resulting in emergence from a state of disordered consciousness. Brainstem structures involved in arousal and consciousness include the reticular activating system and the basal ganglia. There is evidence within the traumatic brain injury, stroke, encephalopathy, and dementia literature of Zolpidem’s usefulness in patients in a coma or disorder of consciousness state with midbrain damage. It remains unclear whether Zolpidem’s effects are specific to midbrain or pontine structures like the reticular activating system, as both structures were affected by this patient’s tumor. Nevertheless, this patient’s response to Zolpidem was significant and robust.

Conclusion: The use of zolpidem for hypersomnolence refractory to traditional neurostimulants in brainstem tumors causing a state of disordered of consciousness should be considered.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/use-of-zolpidem-in-hypersomnolence-due-to-brainstem-tumor-a-case-report/