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Prolonged akinetic mutism due to multiple sclerosis

T F Scott¹, D Lang, R M Girgis

¹Division of Neurology, Medical College of Pennsylvania, Allegheny General Hospital Campus, Pittsburgh, USA.

The Journal of Neuropsychiatry and Clinical Neurosciences

|January 1, 1995

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A young woman with multiple sclerosis experienced severe akinetic mutism, a rare neurological symptom. She eventually recovered spontaneously, suggesting a potential brainstem lesion as the cause.

Area of Science:

Neurology
Neuroimmunology
Psychiatry

Background:

Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
MS can manifest with diverse neurological and psychiatric symptoms.
Akinetic mutism is a rare condition characterized by profound psychomotor retardation, mutism, and apathy.

Observation:

A 25-year-old woman with a history of MS and affective disorder presented with neurological symptoms indicative of active MS.
The most prominent symptom was akinetic mutism, which was refractory to electroconvulsive therapy (ECT), steroids, and stimulants.
Cerebrospinal fluid analysis and MRI confirmed active MS, while SPECT and EEG showed nonspecific abnormalities.

Findings:

The patient's akinetic mutism persisted for 6 weeks.

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Spontaneous recovery from akinetic mutism occurred over a 2-month period.

An acute brainstem lesion identified on MRI was hypothesized as the cause of akinetic mutism.

Implications:

This case highlights the varied and severe neurological presentations of active MS.
The spontaneous recovery suggests potential for neuroplasticity or resolution of inflammatory lesions.
Understanding the etiology of akinetic mutism in MS is crucial for patient management and treatment strategies.