神经科学与心理学2020sciencedirect.com
一种安眠药暂时逆转严重脑损伤与瘫痪
Severe brain injury and paralysis temporarily reversed with a sleeping pill
进阶 · 约 25 分钟读完前置知识：意识障碍与低反应状态的临床基础、神经解剖学基础、病例报告阅读经验
导读
这篇病例报告描述一名因缺氧缺血性脑损伤而长期处于低反应状态、运动不能和缄默的37岁患者，在服用安眠药唑吡坦（Zolpidem）后出现暂时性的觉醒、运动和言语改善。文章提示该药在少数严重脑损伤患者中可能短暂“唤醒”功能，但属于个案观察，机制和适用性仍不明确。
HN 关注点：安眠药竟能短暂逆转严重脑损伤/瘫痪的罕见现象，以及这类药物成瘾和副作用风险。
HN 评论精选
这几条评论里：补充 2 亲历 1
亲历长期Zolpidem成瘾者亲历警告：不要轻易开始服用Z类安眠药。
我服用唑吡坦（Zolpidem）约13年，已经成瘾。我寻求过治疗但没用，因为现在不吃药就睡不着。如果你没吃过Z类安眠药，我强烈建议不要开始，因为从我的经历看，后果大于好处。滥用让我失去了不少朋友、声誉等。你听说过的安眠药相关经历我全都经历过（从迷糊的“嗨”到暴食、奇怪的性行为、精神病性症状，再到撞车）。
bxtt查看英文原文
I’ve been taking Zolpidem for about 13 years now and suffer from addiction. I’ve sought treatment for this but it doesn’t work as now I cannot sleep without taking something. If you haven’t taken Z-type sleeping aids, I would definitely suggest not to start, as from experience the consequences outweigh the benefits. I’ve lost a considerable amount of friends/reputation/etc. from the abuse. Every experience that you hear about from sleeping aids, I’ve been through it (from the loopy fun to binge eating to weird sex to psychosis to crashing my car)
补充补充病例细节：患者严重脑损伤后八年处于低反应、运动不能和缄默状态。
摘录：一名29岁、有酒精滥用史的男性在噎到一块肉后发生缺氧缺血性脑损伤。初期神经功能恢复缓慢，随后自主运动和言语消失。患者觉醒度严重受损，需要强烈的听觉和触觉刺激才能维持清醒。CT未见可解释这种继发性恶化的结构性病变，常规EEG也无癫痫证据。在ICU和神经科住院后，患者被转入养老院，未获得能解释其低反应状态的正规诊断。随访结构MRI显示弥漫性萎缩，无脑积水。八年过去，没有进一步改善和神经随访。最终，一位有低反应障碍经验的新养老院医生接手治疗，并重新进行神经检查以寻找改善照护的方向。临床评估时，现年37岁的患者看似清醒，但完全缺乏自主运动（运动不能）和言语（缄默）。更具体地说，患者没有情感反应，不主动进食或饮水，仍失禁。尽管没有自发言语或应要求发声，他能对问题作出回应……
DoreenMichele查看英文原文
Excerpt: A man, 29-year old, with a history of alcohol abuse suffered from hypoxic-ischemic brain injury after choking on a piece of meat. After an initial, though slow neurological recovery, spontaneous movement and speech disappeared. The patient developed such a severe impairment of arousal that he required intensive auditory and tactile stimulation to maintain a wakeful state. No structural lesions were found using a computerized tomography (CT) scan to explain this secondary deterioration, and conventional EEG-recordings showed no evidence of epilepsy. After a stay in the ICU and neurology department, the patient was transferred to a nursing home without a formal diagnosis explaining his hyporesponsive state. A structural MRI at follow-up showed signs of diffuse atrophy without hydrocephalus. Eight years passed without any further improvement and neurological follow-up. Eventually, a new nursing home physician with experience in hyporesponsive disorders took over the patient's treatment and performed a new neurological examination to find directions to improve his care. Upon clinical assessment, the now 37-year old patient seemed awake, but showed a complete lack of voluntary movement (akinesia) and absence of speech (mutism). More specifically, the patient showed no affective reactions, initiation of eating or drinking, and remained incontinent. Although the patient showed no signs of spontaneous speech or vocalization on request, he was able to respond to questions or commands with movements with a significant delay (usually a couple of seconds) and with evident ataxia and muscle rigidity. Despite his intact awareness, the patient's initiative was so severely impaired that he remained wheelchair-bound and entirely dependent on nursing care for all daily activities, including the need for enteral tube feeding. It's incredible how little we still know about some things. They couldn't pin down a cause and this is apparently a significant detail as to why this patient was basically warehoused in a nursing home with no real treatment for literally years until they tried this new thing, which had some short-lived effects.
补充该现象早有记载，NYT有背景报道，但机制仍不清楚。
Zolpidem因这种现象而闻名，不过它带来的问题多于答案。这一特定现象早在2000年代初就已知；《纽约时报》有一篇不错的文章：https://www.nytimes.com/2011/12/04/magazine/can-ambien-wake-minimally-conscious.html
ComputerGuru查看英文原文
Zolpidem is famous for this, although it’s raised more questions than answers. This particular phenomenon has been known since the early 2000s; NYT has a good write up about it: https://www.nytimes.com/2011/12/04/magazine/can-ambien-wake-minimally-conscious.html
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