Transient Improvement of Aphasia with Zolpidem

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Abstract
There is currently no effective pharmacologic treatment for chronic aphasia, a frequent and incapacitating consequence of hemispheric stroke. We report the case of a 52-year-old right-handed woman, who had a stroke that affected her left insula, putamen, and superior temporal gyrus. Three years later, her speech was still restricted to stereotyped syllables, with not a single identifiable word. Language comprehension was better preserved. Because of occasional insomnia, zolpidem (10 mg) was prescribed. To the amazement of the patient and her family, ingestion of the first dose was followed by a dramatic improvement in her speech, which persisted until the patient went to bed later in the night. On the following morning, aphasia had returned at its usual level of severity. This phenomenon was systematically reproducible, reflecting a regular temporal pattern. About 20 minutes after the ingestion of zolpidem, the patient regained effective speech abilities, and zolpidem did not induce major sleepiness. She then engaged in meaningful, albeit telegraphic, speech, consisting of sentence fragments with accurately selected words. In contrast to her basal status, she could repeat most single words and pseudowords, and the first words of sentences; she was able to name most pictures of objects correctly and count up to 10.

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