Abulia is a clinical syndrome manifested by lack of spontaneity of action and speech, deficiency in initiation, apathy, inertia, mental and motor slowness, reduction in excursion of motion, poor attention, and easy distractibility. Abulia has been conceptualized as laying in a continuum of motivational and emotional deficit in which apathy is at one extreme and akinetic mutism at the other, more severe extreme. Lesions in the frontal lobes have been most often implicated in the causality of abulia, but other areas of involvement have also been described. Some authors have reported the beneficial effect of dopaminergic agents in the treatment of abulia and other related disorders. We report on four patients with various disorders of the CNS and abulic symptoms who had a beneficial response to administration of a carbidopa/levodopa (Sinemet) compound many months after the CNS insult responsible for the symptoms. We hypothesize that levodopa may be beneficial in the treatment of abulia by increasing the availability of dopamine to the prefrontal cortex or related areas in the brain.

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