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Akinetic mutism due to diphenylhydantoin toxicity
S Tütüncüoğlu1, M Kantar, H Tekgül
1Department of Pediatrics, Ege University Faculty of Medicine, Izmir.
Abstract:
Akinetic mutism (AM) is a rare, specific, unconscious state. An AM patient seems to be awake, lacks mental activity, is unable to speak, and does not respond to any environmental stimulus. Cyclical sleep and awake states are maintained, and incontinence is present. Various factors such as tumor, vascular events, drug use and radiotherapy are responsible for the development of AM. A 12-year-old epileptic patient displayed AM and diphenylhydantoin toxicity (DPH). She seemed awake, was unable to speak or to understand, and had no movements with either spontaneous or noxious stimuli. Her serum DPH level was greater than 40 micrograms/ml. Magnetic resonance imaging (MRI) showed mild cerebellar atrophy. All known causes of AM were excluded. The AM state in this patient was considered to be due to toxic DPH levels. She regained her motor and mental activity within two months after carbamazepine was administered to replace DPH. She was symptom-free when examined at the two-year follow-up. No similar adverse effect of DPH has been reported to date.
Insights
Akinetic mutism (AM), a rare unconscious state, was observed in a 12-year-old epileptic patient due to diphenylhydantoin (DPH) toxicity. Treatment with carbamazepine resolved the AM symptoms.
Area of Science:
- Neurology
- Toxicology
Background:
- Akinetic mutism (AM) is a rare neurological condition characterized by apparent wakefulness without mental activity, speech, or response to stimuli.
- Causes of AM include tumors, vascular events, drug toxicity, and radiotherapy.
Observation:
- A 12-year-old epileptic patient presented with AM and elevated serum diphenylhydantoin (DPH) levels (>40 µg/ml).
- The patient exhibited unresponsiveness, mutism, and lack of movement despite stimuli.
- MRI revealed mild cerebellar atrophy; other AM causes were ruled out.
Findings:
- The patient's AM was attributed to DPH toxicity.
- Discontinuation of DPH and initiation of carbamazepine led to the resolution of AM symptoms within two months.
- The patient remained symptom-free at a two-year follow-up.
Implications:
- This case highlights diphenylhydantoin toxicity as a potential cause of akinetic mutism.
- It underscores the importance of monitoring drug levels in patients presenting with unexplained neurological symptoms.
- This adverse effect of DPH has not been previously reported, suggesting a unique patient sensitivity or interaction.