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Chronic akinetic mutism after mesencephalic-diencephalic infarction: remediated with dopaminergic medications

M P Alexander1

  • 1Memory Disorders Research Center, Boston University, Department of Neurology, Massachusetts, USA.

Neurorehabilitation and Neural Repair
|January 29, 2002
PubMed
Abstract

Insights

Dopaminergic treatment, including carbidopa/levodopa and pergolide, effectively improved akinetic mutism (AKM) symptoms in a chronic case. However, persistent apathy suggests abulia involves more than just dopaminergic deficiency.

Area of Science:

  • Neuroscience
  • Neurology

Background:

  • Akinetic mutism (AKM) is a rare disorder with unclear neuropathology and treatment options.
  • The relationship between AKM and abulia remains uncertain.

Observation:

  • A patient with chronic AKM following bilateral mesencephalic ventral tegmental area and lateral hypothalamus infarctions was studied.
  • Dopaminergic treatment was administered to assess its effects on motor function and cognitive status.

Findings:

  • Combination therapy with carbidopa/levodopa and pergolide led to rapid improvement in AKM and functional independence.
  • Despite resolution of akinesia and normal frontal executive functions, an apathetic, amotivational state persisted.

Implications:

  • Late-stage dopaminergic treatment can be effective for akinetic mutism, even after prolonged severe akinesia.
  • Abulia appears to have a complex mechanism beyond simple dopaminergic deficiency, persisting even with AKM treatment and normal cognition.

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