Zibold, Julia; Schmidbauer, Moritz Luigi; Wischmann, Johannes; Dimitriadis, Konstantinos (2024): Case Report: Treatment of akinetic mutism after unilateral anterior cerebral artery infarction with methylphenidate and levodopa/benserazide. Case Reports in Neurology. ISSN 1662-680X
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Abstract
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.
Doc-Type: | Article (LMU Hospital) |
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Organisational unit (Faculties): | 07 Medicine > Medical Center of the University of Munich > Neurological Clinic and Polyclinic with Friedrich Baur Institute |
DFG subject classification of scientific disciplines: | Life sciences |
Date Deposited: | 01. Aug 2024 07:50 |
Last Modified: | 01. Aug 2024 07:50 |
URI: | https://oa-fund.ub.uni-muenchen.de/id/eprint/1352 |
DFG: | Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - 491502892 |