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01.Commentary on Hinz et al. (2011) on the Non-Validity and Clinical Relevance of Neurotransmitter Testing (pp. 515-519)
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Clinical and Brain SPECT Changes in Stroke Patients on Zolpidem Therapy (pp. 435-442) $40.00
Authors:  N.E. Nyakale, R.P. Clauss, H.W. Nel, and M.M. Sathekge
Introduction: Post-ischaemic brain damage can be one of the major sequels following a stroke. Publications on the management of patients who have suffered a stroke focus mainly on the acute phase of the event rather than on long-term brain damage. Previous publications have demonstrated clinical improvements of patients who have suffered brain damage after being given zolpidem for the purpose of sedation. These improvements vary from patient to patient. Measurement of brain function after treatment is essential for adequate assessment.

Aims: The aim of this prospective study is to demonstrate the clinical changes and changes in perfusion of the brain after zolpidem in patients who have suffered brain damage after a stroke. The Barthel index and Brain SPECT imaging were used to measure these changes.

Methods: 12 Patients with confirmed post-ischaemic brain damage following a stroke, who were prescribed zolpidem by their treating doctors, were selected to take part in our study. The Barthel index of the selected patients was below 100/100. All selected patients underwent a Brain SPECT scan using the radiopharmaceutical 99mTc-HMPAO (hexamethylpropyleneamine oxime) before starting with the zolpidem. Patients were then initiated on 10mg daily oral dose of zolpidem. A second SPECT brain scan was conducted within 2 weeks of initiation of zolpidem and a follow up Barthel index was done at 6 months.

Results: There was significant improvement in perfusion of the brain and clinical condition of patients after treatment with zolpidem. The overall improvement on Barthel index was significant (p=0097), improving from a mean of 60.8 (SD 30.88) to a mean of 74.58 (SD 29.88). 8/12 (66.7%) of the patients demonstrated improvement in the Brain SPECT perfusion scans with zolpidem. In 62.5% of these patients, there was a significant concurrent improvement on the Barthel index from a mean of 65 (SD 28.3) to 83 (SD19.8), (p=0.0295). The mean improvement in the Barthel Index of patients who showed no improvement in their scans was markedly lower, from a mean of 52.5 (SD 38.6) to 56.3 (SD 41.1), p = 0.1615.

Conclusion: Brain SPECT and the Barthel Index were able to show improvements on zolpidem in the brain function of patients after brain damage, demonstrated by improved perfusion of brain tissue and improved clinical response. 

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Clinical and Brain SPECT Changes in Stroke Patients on Zolpidem Therapy (pp. 435-442)