Akinetic mutism

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Akinetic mutism
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Lack of speech, lack of movement, apathy
Complications	Social withdrawal, depression
Onset	Can occur at any age
Duration	Variable, depending on cause
Types	Frontal, mesencephalic, thalamic
Causes	Brain injury, stroke, tumor, neurodegenerative disease
Risks	Traumatic brain injury, cerebrovascular accident
Diagnosis	Clinical assessment, neuroimaging
Differential diagnosis	Locked-in syndrome, catatonia, coma
Prevention	N/A
Treatment	Rehabilitation, medication, surgery
Medication	N/A
Prognosis	Depends on underlying cause
Frequency	Rare
Deaths	N/A

A neurological condition characterized by a lack of movement and speech

Midsagittal view of the human brain

Illustration of the thalamus

Akinetic mutism is a rare neurological disorder characterized by a lack of voluntary movement (akinesia) and speech (mutism). Individuals with this condition appear alert and awake but do not initiate movement or speech. This condition is often associated with damage to specific areas of the brain, particularly those involved in motivation and consciousness.

Pathophysiology

Akinetic mutism is typically caused by lesions in the frontal lobe or the thalamus, which are critical areas for initiating movement and speech. The frontal lobe is responsible for executive functions, including decision making, problem solving, and control of behavior. Damage to this area can result in a lack of motivation to move or speak. The thalamus acts as a relay station for sensory and motor signals to the cerebral cortex. Lesions in the thalamus can disrupt these pathways, leading to the symptoms of akinetic mutism. Additionally, damage to the basal ganglia and cingulate gyrus can also contribute to the condition.

Clinical Presentation

Patients with akinetic mutism may appear awake and alert, with their eyes open, but they do not respond to external stimuli or initiate voluntary actions. They may follow objects with their eyes and show some reflexive movements, but purposeful actions are absent. Speech is typically absent, although some patients may produce occasional sounds or words.

Causes

Akinetic mutism can result from various causes, including:

• Stroke
• Traumatic brain injury
• Brain tumors
• Infections affecting the brain, such as encephalitis
• Neurodegenerative diseases

Diagnosis

Diagnosis of akinetic mutism involves a thorough neurological examination and imaging studies such as MRI or CT scan to identify lesions in the brain. Electroencephalography (EEG) may also be used to assess brain activity.

Treatment

Treatment of akinetic mutism focuses on addressing the underlying cause of the condition. This may involve surgical intervention, medication, or rehabilitation therapies. Speech therapy and physical therapy can help improve communication and motor skills.

Prognosis

The prognosis for individuals with akinetic mutism varies depending on the underlying cause and the extent of brain damage. Some patients may recover partially or fully with appropriate treatment, while others may have persistent symptoms.

See also

• Frontal lobe
• Thalamus
• Basal ganglia
• Consciousness