We were very interested in the cases of transient unresponsiveness in elderly patients reported by Haimovic and Beresford,1 and also in the letter by Rao et al,2 describing three patients with transient and repeated episodes of total unresponsiveness and without any other neurologic abnormality. Having described a syndrome of recurring stupor or coma episodes (idiopathic recurring stupor) responsive to flumazenil and related to increased amounts of endozepine-4 in plasma,3-5 we wonder whether the cases described by Haimovic and Beresford and Rao et al could really be cases of idiopathic recurring stupor. Although electroencephalography is described as slow, the clinical and laboratory characteristics seem to us fairly similar to idiopathic recurring stupor. We, therefore, suggest that these patients be challenged with flumazenil and that their plasma and cerebrospinal fluid be examined for endozepine levels.
Tinuper P, Montagna P, Plazzi G, Lugaresi E. Transient Unresponsiveness in the Elderly: Possible Episodes of Idiopathic Recurring Stupor. Arch Neurol. 1995;52(3):232. doi:10.1001/archneur.1995.00540270018007