Case Report: Treatment of Akinetic Mutism after Unilateral Anterior Cerebral Artery Infarction with Methylphenidate and Levodopa/Benserazide.

Autor: Zibold J; Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany., Schmidbauer ML; Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany., Wischmann J; Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany., Dimitriadis K; Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
Jazyk: angličtina
Zdroj: Case reports in neurology [Case Rep Neurol] 2024 May 28; Vol. 16 (1), pp. 136-141. Date of Electronic Publication: 2024 May 28 (Print Publication: 2024).
DOI: 10.1159/000539033
Abstrakt: Introduction: Akinetic mutism is a severe state of impaired volition that can result from a stroke. Its therapeutic evidence relies on single case reports that used atomoxetine or levodopa with variable latency and efficacy.
Case Presentation: We present the case of a 54-year-old woman who developed akinetic mutism after infarction in the territory of the right anterior cerebral artery, successfully treated with methylphenidate and levodopa/benserazide. Clinical examination showed a patient lacking any spontaneous speech and movement while opening her eyes and fixating. Suspecting akinetic mutism after a comprehensive diagnostic work-up, we started an individual therapy attempt with methylphenidate 10 mg and levodopa/benserazide 100/25 mg twice daily. Both drugs affect the dopaminergic and noradrenergic transmission in the frontal-subcortical circuit, compromised in akinetic mutism. We saw rapid and sustained improvement in her volitional actions, devoid of side effects. Finally, the patient was actively communicating and moving her limbs.
Conclusion: We discuss the patient's favorable clinical course in response to the synergistic combination of methylphenidate and levodopa/benserazide, emerging as a promising treatment strategy, and provide a brief literature review of treatment options in akinetic mutism following stroke.
Competing Interests: The authors have no conflicts of interest to declare.
(© 2024 The Author(s). Published by S. Karger AG, Basel.)
Databáze: MEDLINE
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