This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lazar, R. M. Articles by Robinson, J. V. Search for Related Content PubMed PubMed Citation Articles by Lazar, R. M. Articles by Robinson, J. V. Related Collections Behavioral Changes and Stroke Rehabilitation, Stroke Other Stroke Treatment - Medical

(Stroke. 2002;33:283.)
© 2002 American Heart Association, Inc.

Research Reports

Reemergence of Stroke Deficits With Midazolam Challenge

Ronald M. Lazar, PhD; Brian-Fred Fitzsimmons, MD; Randolph S. Marshall, MD; Mitchell F. Berman, MD; Maria A. Bustillo, MD; William L. Young, MD; J.P. Mohr, MD; Jinesh Shah, BA Julie V. Robinson, BA

From the Departments of Neurology (R.M.L., B-F.F., R.S.M., J.P.M., J.S., J.V.R.) and Anesthesiology (M.F.B., M.A.B.), Columbia University College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, NY, and School of Medicine, University of California at San Francisco (W.L.Y.).

Reprint requests to Dr Ronald M. Lazar, The Neurological Institute, 710 W 168th St, New York, NY 10032. E-mail ral22{at}columbia.edu

Abstract

Background and Purpose— Patients who have sustained a neurological injury and then improved may experience transient reemergence of their syndromes when given benzodiazepines. As a step toward assessing whether neurotransmitter systems underlie poststroke clinical improvement, we selected midazolam, a -aminobutyric acid_A (GABA_A) agonist, for systemic administration to measure general or stroke-specific effects in patients.

Methods— Eight patients with image-verified stroke (5 with left-sided and 3 with right-sided cerebral lesions) participated. The strokes had occurred from 7 days to 6 years earlier, with patients showing clinical improvement from their initial syndromes. Each patient underwent baseline testing for motor function, aphasia, and left hemispatial neglect, after which intravenous midazolam was delivered until mild drowsiness was detected. Patients were tested during this period and again after 2 hours when sedation had dissipated.

Results— After the administration of midazolam, the 5 patients with left hemisphere stroke demonstrated reemergence or worsening of their initial right hemiparesis and aphasia but showed no left neglect. The 3 patients with right cerebral stroke showed reemergence of left hemiparesis and left visual field neglect but no aphasia. All patients returned to baseline after 2 hours.

Conclusions— Under conditions of light sedation, patients whose initial stroke syndrome had substantially improved clinically showed transient reemergence of their initial focal syndrome. These data suggest a possible role for GABA_A-mediated neurochemical mechanisms in poststroke improvement and sensitivity to medication effects.

Key Words: cognition • GABA • midazolam • stroke outcome

This article has been cited by other articles:

				D. M. Hermann and C. L. Bassetti Sleep-related breathing and sleep-wake disturbances in ischemic stroke Neurology, October 20, 2009; 73(16): 1313 - 1322. [Abstract] [Full Text] [PDF]

				J. U. Blicher, J. Jakobsen, G. Andersen, and J. F. Nielsen Cortical Excitability in Chronic Stroke and Modulation by Training: A TMS Study Neurorehabil Neural Repair, June 1, 2009; 23(5): 486 - 493. [Abstract] [PDF]

				C. M. Butefisch, M. We ling, J. Netz, R. J. Seitz, and V. Homberg Relationship Between Interhemispheric Inhibition and Motor Cortex Excitability in Subacute Stroke Patients Neurorehabil Neural Repair, February 1, 2008; 22(1): 4 - 21. [Abstract] [PDF]

				V. W. Mark, A. J. Woods, K. K. Ball, D. L. Roth, and M. Mennemeier Disorganized search on cancellation is not a consequence of neglect Neurology, July 13, 2004; 63(1): 78 - 84. [Abstract] [Full Text] [PDF]

				R. M. Lazar, B.-F. Fitzsimmons, R. S. Marshall, J.P. Mohr, and M. F. Berman Midazolam Challenge Reinduces Neurological Deficits After Transient Ischemic Attack Stroke, March 1, 2003; 34(3): 794 - 796. [Abstract] [Full Text] [PDF]

				D. J. Gladstone, S. E. Black, and A. M. Hakim Toward Wisdom From Failure: Lessons From Neuroprotective Stroke Trials and New Therapeutic Directions Stroke, August 1, 2002; 33(8): 2123 - 2136. [Abstract] [Full Text] [PDF]

				V. Di Piero, S. Di Legge, M. Altieri, G. L. Lenzi, R. M. Lazar, R. S. Marshall, and J.P. Mohr When Is a Stroke Actually "Stable"? * Response Stroke, June 1, 2002; 33(6): 1456 - 1457. [Full Text] [PDF]