Zolpidem (Ambien), often used to treat insomnia and induce sleep, can (according to this article) also improve motor symptoms in those with Progressive Supranuclear Palsy (PSP). There is no mention of any long-term research and it must be pointed out that it would appear that the prolonged use of this drug may have serious side-effects including the possibility of increasing the speed of the progression of the disease.
You also need to always remember that things do change. Always check out - as best you can - any articles that have to do with medicating any disease. Check the Internet under the name of the medication for any additional available pertinent information regarding its usage and possible side-effects. If in doubt check with your medical advisor and those on the PSPInformation listserv who also may be able to help.
Correspondence
To the Editor:
Progressive supranuclear palsy is an atypical Parkinsonian syndrome characterized by motor symptoms (voluntary-eye-movement abnormalities, akinesia, rigidity, postural instability, dysarthria, and dysphagia), personality changes, and cognitive impairment. It is refractory to pharmacologic treatment. Since reduced neurotransmission of (gamma)-aminobutyric acid (GABA) in the striatum and globus pallidus could contribute to the symptoms of progressive supranuclear palsy, drugs that act specifically on the GABAergic systems in the basal ganglia might be helpful in the disorder.[1]
Zolpidem, a short-acting hypnotic drug, can improve motor symptoms in patients with Parkinson's disease.[2]
This GABAergic drug is a selective agonist of the benzodiazepine subtype receptor BZ1. The highest density of this receptor is in the output structures of the basal ganglia (i.e., the ventral globus pallidus and the substantia nigra pars reticulata).[3] We observed a 58-year-old man with a five-year history of progressive supranuclear palsy who, after a single 10-mg dose of zolpidem, showed marked improvement of akinesia, rigidity, dysarthria, and voluntary eye movements.
A double-blind, placebo-controlled crossover study was then conducted in 10 patients with "probable progressive supranuclear palsy" according to current diagnostic criteria,[4] who gave informed consent. The patients received single oral doses of zolpidem (5 and 10 mg), levodopa-carbidopa (250 mg of levodopa and 25 mg of carbidopa), or placebo in four separate trials in random order. In each trial, motor performance was assessed by the Unified Parkinson's Disease Rating Scale, part III, before treatment and one hour after treatment. The criterion for a positive motor response was a decrease of >20 percent from base line in the score.[5] Voluntary saccadic eye movements were assessed clinically.[4]
Zolpidem, unlike levodopa or placebo, decreased voluntary saccadic eye movements and, at a 5-mg dose, induced a statistically significant improvement of motor function.
Two patients with mild-to-moderate progressive supranuclear palsy showed an improvement of >20 percent, with amelioration of akinesia and rigidity. Beneficial effects were detectable 40 to 60 minutes after administration and lasted about 2 hours. Adverse effects of zolpidem were drowsiness and increased postural instability and were more marked after a 10-mg dose.
This pilot study suggests that zolpidem can ameliorate motor symptoms in patients with progressive supranuclear palsy. The decrease in voluntary eye movements after pharmacologic treatment has not to our knowledge been previously reported. Such motor improvement may be due to selective inhibition by zolpidem of GABAergic inhibitory neurons in the internal globus pallidus and substantia nigra pars reticulata, resulting in activation of the thalamus and cerebral cortex.[2] By inhibiting the substantia nigra pars reticulata, zolpidem could also activate the superior colliculus, which facilitates saccadic eye movements.
Antonio Daniele, M.D., Ph.D.
Elena Moro, M.D.
Anna Rita Bentivoglio, M.D., Ph.D.
Catholic University
00168 Rome, Italy
