Pill 'reverses' vegetative state

[iGav]

How bizarre...

Rinky dink link

[Zeke]

Crazy stuff...reminds me of this movie Awakenings

http://www.imdb.com/title/tt0099077/

which is apparently based on a true story.

[floriflee]

^^^ My thoughts exactly. It sounds very similar to the story. I just wonder what the long term effects of the drug would be.

[2nyRiggz]

Great....imagine the price of that pill.....poor people won't get it..


Bless

[wordmunger]

Originally Posted by 2nyRiggz

Great....imagine the price of that pill.....poor people won't get it..


Bless

Most of the time, poor people don't have the luxury of a persistent vegetative state. They just die.

[2nyRiggz]

Originally Posted by wordmunger

Most of the time, poor people don't have the luxury of a persistent vegetative state. They just die.

Thats the truth. wrap them up and bury em.



Bless

[IJ Reilly]

Originally Posted by floriflee

^^^ My thoughts exactly. It sounds very similar to the story. I just wonder what the long term effects of the drug would be.

The medical condition portrayed in the movie is very different, though.

[floriflee]

Originally Posted by IJ Reilly

The medical condition portrayed in the movie is very different, though.

I realize that, but nevertheless I still wonder how the drug would work long-term for patients with PVS (assuming they determine that the candidates they tested have actual PVS).

[noaccess]

Originally Posted by 2nyRiggz

Great....imagine the price of that pill.....poor people won't get it..


Bless

$104.99 for 30 tablets, to be exact...
Zolpidem's been on the market for years (Ambien). Used to take it for insomnia.

[mkrishnan]

That's really interesting...I wanna look up the scientific article to understand if any imaging was done on these individuals. I tend to also think that what was observed was not the classical concept of a PVS .... awww, poo... we don't have electronic access to current issues -- it's one of those subscriptions where we only get issues one year old or older....

Anyway, here is the scientific abstract:

Neurorehabilitation, Volume 21, Number 1 / 2006, 23 - 28.

Drug induced arousal from the permanent vegetative state

Ralf Clauss A1 and Wally Nel A2

A1) Nuclear Medicine Department, Royal Surrey County Hospital, Guildford, UK
A2) Family Practice, Pollack Park, Springs, South Africa

Abstract:

Background: Zolpidem is an omega 1 specific indirect GABA agonist that is used for insomnia, but may have efficacy in brain damage. The long term efficacy of zolpidem in the permanent vegetative state is described in three patients.

Method: Two motor vehicle accident patients and one near drowning patient, all of them in the permanent vegetative state for at least three years, were rated according to the Glasgow Coma and Rancho Los Amigos scale before and after zolpidem application. Long term response to daily application of this drug was monitored for 3-6 years.

Results: All patients were aroused transiently every morning after zolpidem. Glasgow Coma Scale scores ranged from 6-9/15 before to 10-15/15 after zolpidem. Rancho Los Amigos Cognitive scores ranged from I-II before to V-VII afterward. Drug efficacy did not decrease and there were no long term side effects after 3-6 years daily use.

Conclusion: Zolpidem appears an effective drug to restore brain function to some patients in the permanent vegetative state.

[cslewis]

Hmm. I didn't read too closely, but does anyone remember the Terri Schaivo case from a few months ago? I wonder if this pill would have saved her...

[floriflee]

Originally Posted by noaccess

$104.99 for 30 tablets, to be exact...
Zolpidem's been on the market for years (Ambien). Used to take it for insomnia.

One side effect of Ambien is that it has been known to cause some patients to sleepwalk/sleep eat when it was taken for an extended period of time.

My old boss took it for a while until it was linked to his blackouts during the day.

More research definitely needs to be done.

[mkrishnan]

Originally Posted by floriflee

One side effect of Ambien is that it has been known to cause some patients to sleepwalk/sleep eat when it was taken for an extended period of time.

This is sounding more and more like the plot of a zombie movie!

I really wanna pull that article and read it...I think I might go to the library (Ugh, actual print articles? Published in 2006? ) and find it tomorrow.

[amin]

The article uses the term PVS incorrectly.

Patient N had been "constantly screaming", but stopped after being given the drug when he started watching TV and responding to his family.

People in a PVS do not constantly scream. If Dr. Clauss is including a screamer in a study about PVS, he is way out there. This type of irresponsible account gives false hope to those whose loved ones have zero chance of meaningful recovery.

[jaysmith]

but do people normally get better after being in such a state? I could care less about side effects if i'm conscious and able-bodied. then again i never really read up on this, excuse my possible ignorance.

[mkrishnan]

Originally Posted by jaysmith

but do people normally get better after being in such a state? I could care less about side effects if i'm conscious and able-bodied. then again i never really read up on this, excuse my possible ignorance.

No... as I understand it, as normally defined, people in this kind of state stay that way (unresponsive) as long as they're kept on life support, and die otherwise. The standard view is that there's too much brain damage for recovery to be a serious possibility.

[Don't panic]

double post, so i'll fill with this:

[Don't panic]

if true it's pretty amazing.

i'm a bit puzzled that a result of this potential magnitude (the study has gone on for 6 years) wasn't published in a better journal.

here is some more info:

ReGen announces publication showing reversal of effects of severe brain injury
by zolpidem


ReGen Therapeutics Plc ('ReGen' or 'the Company') is developing an important new
use for zolpidem, a long-established and safe treatment for insomnia.


Today the Company announces the publication of an article in volume 21 pages 23
- 28 of the journal Neurorehabilitation (Clauss, R P and Nel, W H)* showing that
the 'arousal' effect of zolpidem in three subjects in a permanent vegetative
state resulting from brain damage is maintained after daily treatment over a
period of up to six years. The publication states that the new use was first
seen in a thirty-year old man who was mute, incontinent and in permanent spasm
after a severe traffic accident three years earlier. When given zolpidem for
restlessness one night he was able to communicate verbally, spasms relaxed and
he recognised people around him for the first time since the accident. The
effect lasted while zolpidem remained in the body and has been repeated with
gradually improving effect for six years since the first dose.


The three subjects referred to in the publication, two motor vehicle accident
patients and one near drowning patient, all of them in the permanent vegetative
state for at least three years, were rated using well-accepted debility scales
before and after daily treatment with zolpidem. Long-term response was monitored
for between three and six years. All patients were aroused transiently every
morning after zolpidem. Drug efficacy did not decrease and there were no side
effects after up to six years daily use.

Brain scans known as SPECT have also been carried out to show which brain
tissues were functioning and they showed that dormant areas of the brain became
active while zolpidem remained in the body. The change coincided with the
clinical improvements. Hitherto the dormant areas were considered irreversibly
damaged.


A significant number of patients has now been treated by Dr Nel with beneficial
effects after strokes, birth injury and Bell's palsy. The clinical effect is
generally proportional to the size and position of the dormant area and
correlates with predicted drug levels in the brain/plasma.


Commenting, Percy Lomax, ReGen Chairman and Chief Executive said 'It is
encouraging that the effect is so beneficial to patients, that it is maintained
over a long period and that the drug is well tolerated. Sleepiness appears to be
the main if not sole disadvantage, but we believe that can be minimised to
acceptable levels with new formulations.


With this in mind, ReGen is now undertaking a Phase IIa 'clinical proof of
concept' study in South Africa in known zolpidem responders led by our
subsidiary Guildford Clinical Pharmacology Unit Ltd. This study will compare a
new formulation with an existing tablet formulation, hoping to achieve efficacy
but without sedation. The results will be used to find a commercial partner to
complete formulation, clinical development and marketing.'


Given that stroke alone is the largest single cause of severe disability in
England and Wales, with over 250,000 people being affected at any one time, the
Company believes that zolpidem represents a significant medical and commercial
opportunity. ReGen estimates suggest that the total potential world market for
zolpidem in this new use is around $4.3bn per annum.


* Since writing this research Drs Clauss and Nel have become consultants and
shareholders of ReGen as a result of the acquisition of Sciencom Limited on 14
February 2006.

[sushi]

This is really interesting.

We know so little about the brain, and our bodies for that matter.

[jaysmith]

Originally Posted by mkrishnan

No... as I understand it, as normally defined, people in this kind of state stay that way (unresponsive) as long as they're kept on life support, and die otherwise. The standard view is that there's too much brain damage for recovery to be a serious possibility.

so why would people worry about side effects? no matter how bad they may be, its still beats bein g a vegetable aand dying inevitably. amazing how people can discover such a pill though.

[mkrishnan]

Originally Posted by jaysmith

so why would people worry about side effects? no matter how bad they may be, its still beats bein g a vegetable aand dying inevitably. amazing how people can discover such a pill though.

Well... according to traditional wisdom, and the pile of data on this topic up to the point of this piece of research, there is relatively little practical point in sustaining someone in a PVS. The two reasons people do it are because the family needs to feel like they're still fighting, and because there's the off chance some sort of cure or rehabilitation will be developed in the future while the person is being sustained....

But, from what Don't Panic posted, it sounds like these individuals might have had a relatively mild PVS -- I thought in a lot of "classical" cases, the "dormant" area is almost the entire cortex. Which, if I understand the logic proposed, would mean that zolpidem still wouldn't work.

Like in the case of Schiavo, most of the neurologists and neuropsychologists I interacted with around the time felt that she had no chance of recovery based on available or forseeable technology. This is a strange result, and it's way off the track of what's been published before, as far as I know, although traumatic brain injuries are not my area of expertise.

I'm going to go across the street and try to find this article at lunchtime.

[AhmedFaisal]

Originally Posted by mac_head101

Hmm. I didn't read too closely, but does anyone remember the Terri Schaivo case from a few months ago? I wonder if this pill would have saved her...

That would require a brain to begin with. Terri's brain was pretty much gone by the time they finally took her off life support.
Cheers,

Ahmed

[mkrishnan]

Our library doesn't carry this journal in print either.

[the ford prefec]

Only just came across this thread - I know it's old but here is a link to a recent UK article.

http://www.mirror.co.uk/news/tm_obje...name_page.html

Regen Therapeutics also seem to do something called collostrinin (derived from cow colostrum!) which according to research also seems to have an effect on brain function - plenty of patents:

http://v3.espacenet.com/results?sf=a...&IC=&=&=&=&=&=

and some proof of it working but not yet available. Apparently an over the counter "nutraceuticle" will be made by sterling technology:

http://www.bestcolostrum.com/home


Cheers
Mike

[bousozoku]

Originally Posted by mac_head101

Hmm. I didn't read too closely, but does anyone remember the Terri Schaivo case from a few months ago? I wonder if this pill would have saved her...

I heard about this on the local news show last night. They specifically mentioned that it wouldn't have helped Terri Schiavo.