________________________________________________________________________________
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.
Several years ago I experienced a (thankfully temporary) severe reduction in brain function, for several weeks. I was shocked by the truly abysmal diagnostic capability of modern neuromedicine for anything less than large-scale physical trauma. In my case, they couldn't pin down a cause at all, except to say that the symptoms were consistent with a viral infection of the CNS. What virus? Who knows, we can only test for a handful of them.
When neurologists just postulate virus to explain the problems like you had, they are just BSing. Oliver Sacks described many cases of neurosyphilis in his books. These doctors are just extrapolating based on that.
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-...
https://en.wikipedia.org/wiki/Zolpidem#Research
_treatment effective in the short term, but only in a small proportion of cases (estimated at around 5%)_
After taking it for sleep, I think it should be researched for way more. It’s clearly rewiring things.
Can you elaborate on your experience with it? I’m super curious about that.
Ah, the video at the bottom of the paper is really emotional! I hope they can figure out how to prolong the effects. Still, an hour of lucidity and verbal communication and a stroll every few weeks and a visit with the family is infinitely better than nothing at all.
Things like these makes me realize how little we know about the functioning of brain. Manipulating brain digitally would be perhaps one of the biggest technological revolution after industrial revolution.
I saw a paper describing a clinical trial of a device which electrically stimulates the median nerve to reduce the severity of tourette's symptoms.
This would be game changing to the Tourette's community. It is so much more than just a speech or tic disorder, and to give the worst affected sufferers their lives back (by reducing the impact of disinhibition, etc) is a fucking miracle.
Sometimes I wish I was smart enough to have gotten involved with things like neuroscience. I watched part of a lecture on certain brain functions a good while back, regarding the mechanics of various mental illnesses, and it was incredibly fascinating. Such a powerful organ that we simply can't understand well enough.
You probably are smart enough. It’s never to late to learn and contribute.
This is true. I pivoted from EE to Neuroscience after several years in industry.
That’s basically singularity
Sci-Hub link:
https://sci-hub.do/10.1016/j.cortex.2020.08.011
Reading the HN title, I was immediately reminded of the Oliver Sacks book Awakenings[1]. He discovered that the drug L-DOPA could temporarily awaken encephalitis patients from a coma-like state. I wonder if the article's title "Awakening after a sleeping pill" is a reference to that book.
1.
https://en.wikipedia.org/wiki/Awakenings_(book)
There's a House M.D. episode about this. It's one of my favourite episodes, but if you weren't already following the show it wouldn't be the best one to start on, as it involved Wilson doing a lot of analysis on House's way of thinking which you'd lack context on.
https://en.m.wikipedia.org/wiki/Son_of_Coma_Guy
This reminded me of the treatment of Encephalitis lethargica [i] and the temporary effect of L-dopa (as made famous in the movie _Awakenings_).
[i]
https://en.wikipedia.org/wiki/Encephalitis_lethargica
Zolpidem, I use this pill to sleep and works fantastic for me. My MD told me that regular use could lead to dementia and the risk for addiction is considerable. I've tried antidepressants to sleep but always wake up with a headache, the feeling of it it's not great either. But with this one, never had an issue.
Ever tried Hydroxyzine for sleep? It's an anti-anxiety med that was prescribed to me for insomnia after zolpidem and the other popular non-benzo hypnotics had the opposite effects on me.
Hydroxyzine works ok for me. Not great. Flexirol + hydrocodone work fantastic for me, but that's not a viable option.
Dementia as a side effect? Aren’t you scared of that?
Check this out:
Zolpidem may cause serious or possibly life-threatening sleep behaviors. Some people who took zolpidem got out of bed and drove their cars, prepared and ate food, had sex, made phone calls, sleep-walked, or were involved in other activities while not fully awake. After they woke up, these people were unable to remember what they had done. Tell your doctor if you have ever had an unusual sleep behavior while taking zolpidem. Be sure that your family or caregiver are aware that these symptoms are serious and to call your doctor if they occur. Stop taking zolpidem and call your doctor right away if you find out that you have been driving or doing anything else unusual while you were sleeping.
https://medlineplus.gov/druginfo/meds/a693025.html
It’s a crap calculation but dementia years away is better than a life without proper sleep. You might not make it to those dementia years or skip it through some other process-like not triggering it. I’ve accepted similar trade offs with medication for chronic migraine (as in literally every day sometimes multiples per day). Functioning today definitely matters more than decades down the road if that’s what it truly takes.
I take medication that results in Parkinsonism Syndrome to some extent. It sucks, and it's very frustrating when it manifests.
That said, without the medication I'd be miserable and might not even be alive.
One of these is better than the other, so it's the choice I make.
L-Dopa by chance?
People making choices of that sort are almost always much more afraid of something else, that "something else" being what happens if they don't treat for X. If they had better options, they would be all over them.
https://www.youtube.com/watch?v=4kWKvDj3jD4
Update
https://www.youtube.com/watch?v=VUnBPOO9Qmw
What happens when the sleeping pill wears off? Does the patient revert to his previous state until administered another dose, or does a single dose permanently change the patient?
> _After consultation with his family, a single dose of zolpidem (10 mg) was administered by the nursing home physician. This dose is frequently used for patients with persistent hyporesponsive disorders (Bomalaski et al., 2017). Within 20 min, the patient started communicating spontaneously, asking the nurse how his wheelchair was to be operated, and requesting fast food. He managed to walk while being supported by the staff and phoned his father, who had not heard his son's voice for years. Despite evident retrograde amnesia, going back three years before the brain injury, and an apparent hearing deficit, he was cheerful, alert, and showing interest in the people and objects surrounding him._
> _Two hours after zolpidem administration, he gradually fell back into his diminished motivational state._
It's great that he's able to "come back" for a little while, but it must be so sad for his loved ones to see him revert to the diminished state.
It would seem they revert back to their previous state, since it mentions 'temporary'
They revert when it wears off.
Essentially they come back to life for a bit and then slither back to their vegetative state.
You could phrase this much more kindly.
I believe it would be on you to interpret it more charitably. I'm unsure how you've found a way to take offense with words that aren't readily associated with malice.
I'll bite, assuming good intent. (Though one's intended interpretation doesn't invalidate another's unexpected interpretation...) so here we go:
"Slither" can reasonably be associated with snakes, for which allusions are aplenty. The choice of word demonstrates a deliberate creativity that invited 6 the reader to consider whether there's deliberate underlying intent in the creative choice.
The "to life" comment takes an opinioated stance on the essence of what it means to be a living being, a controversial and deeply divisive topic for centuries.
Did you intend to inspire these interpretations? I doubt it. But is it reasonable to conclude you might have? Absolutely
No blame warranted, either way. Communication is flakey. ::shrug::
Communication is far less flakey when the default is a charitable interpretation.
As for your other points, I highly doubt such a simple comment intended to touch on the complexities of what it means to be alive - any interpretation otherwise seems to be reaching hard to find a complex technical fault compared to the alternative of interpreting with hospitality and arriving at the conclusion that it was a simple colloquialism intended to describe the situation.
Also, judging by your comment you seem to believe I'm the one who made the comment that was interpreted as unkind.
Your bizarre use of "malice" explains a lot about why you don't see how "slither" and "come back to life" are plainly uncharitable phraseology to associate with people dealing with tbi. If you can't figure that out, buddy, I don't know what to tell ya.
I think you are off base here. OP’s comment isn’t malicious.
Living through TBI is hell. Thankfully I found a legit brand of CBD whose creators made me a custom blend. Now I'm fully recovered: www.Jampha.com
Hopefully this doesn’t work