Twenty to forty percent of people who suffer a severe brain injury do not survive. Of those that do, a diagnosis can often be hard to reach.
With no proven treatment to improve or speed up recovery from a minimally conscious state, many families are told there is "no hope." There is however, a medication that for some, has the remarkable side effect of "waking" patients up.
Roughly 300,000 people in the U.S. are trapped in a vegetative or minimally conscious state. Causes range from bad accidents to falls, violence and other types of brain trauma.
Unlike a coma, a vegetative state is classified as being unconscious except for some eye opening and periods of wakefulness.
The patient may moan when their muscles are stretched, may cry or smile, track objects with their eyes and react to sounds.
About 50% of patients who are in a vegetative state one month after traumatic brain injury recover some degree of consciousness, yet in many cases they drift in and out and only make minimal progress.
As a result, doctors without experience in treating this type of trauma often rule out the possibility of recovery and patients end up living out their days in hospital rooms or nursing homes.
"The doctors say, 'Oh you're not going to make it.' And they MAKE IT,' noted Dr. Lori Grafton, Director of the Brain Injury Program at Carolinas Rehabilitation. "Then they come to rehab and the families say, 'OK what do we do now?'
Doctor Lori Grafton, a physiatrist, says that in some cases the answer may be: Ambien.
Ambien is a pharmaceutical drug designed to help people sleep by lowering overall brain activity. Yet in some cases, when used for experimental and unintended purposes, the medication has the unexplained effect of "awakening" victims of brain trauma.
The exact mechanism behind this paradoxical response is still a mystery.
One theory based on EEG results, suggested that the cerebral cortex (the "thinking" part of the brain) is disconnected after trauma. Ambien may be able to "turn on" a switch that turns on the connections between the striatum, thalamus and cerebral cortex.
Another way of looking at it: if brain trauma inhibits overall brain activity and Ambien lowers brain activity to help people sleep, then, Ambien may be "inhibiting the inhibition" to allow for wakefulness.
"It's rare - it's not something that works all the time," cautioned Grafton. "But from my standpoint it's worth a try, especially for these patients where nothing else has worked."
Take George Melendez who was nearly dead when pulled from his wrecked car. The near-drowning and brain trauma left the then 23-year-old in a minimally conscious state.
In 2002 a doctor prescribed zolpidem (Ambien) to calm his nighttime fits and within 10 minutes his mother saw his eyes open and become able to respond to questions about his life before the accident.
Grafton has seen the phenomenon with her own eyes.
"It's not like they stand up from their wheelchairs and walk," she points out. "It's been more their ability to communicate or understand."
Casually called "Ambien Awakenings," they are unfortunately not a cure for the estimated 1 in 15 patients that the medication helps. After a few hours, the drug wears off and the patient slips back into oblivion until the next dose.
"It puts us in a very challenging position, especially after I see patients with severe brain injury, because we don't want to give false hope," says Grafton. "There are so many things we don't know."
It's unlikely that more information will be revealed from the pharmaceutical industry, says Board Certified Psychiatric Pharmacist Jerry McKee.
"Nobody will touch it in terms of further research," bluntly states Jerry McKee, Dean at Wingate University-Hendersonville.
That's because Ambien now has generic options, which largely deflates any profits to be made off breakthrough research.
"It takes billions and billions of dollars to bring a drug to market and there's nothing preventing a provider from using an approved med for an unapproved use," explained McKee. "So you're not going to see a lot of research dollars invested when the economic return is just not going to be there."
Still, for some families, there is hope – but not without struggle. Caregivers often have to specifically ask doctors to explore experimental options – like Ambien – or, ask for a referral to a rehabilitation clinic that houses the resources they need.
In many cases, small community hospitals can only do so much without the expertise to develop the extensive therapy regime needed. The same is true for nursing homes.
While news about Ambien can be encouraging, it can also complicate the decision-making process as to whether or not to continue care.
Typically, once a patient progresses to minimal consciousness it's hard to predict what will happen next, making a long-term prognosis almost impossible to determine.
As time passes and more experimental therapies are tried, the option to end care can often pass because the patient eventually starts breathing on their own.
At this point, should a family decide to end any suffering, the process would require the removal of any feeding tubes or the decision to let a new bacterial infection take over.
Meanwhile, families bear a heavy financial burden keeping their loved one in hospital care receiving specific tests and assessments.
Sanofi U.S., the manufacturer of Ambien was not able to comment on this report, saying that the Food and Drug Administration does not allow them to comment on any unintended use of their pharmaceutical products.
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