Prolonged akinetic mutism due to multiple sclerosis

Abstract

A 25-year-old woman with multiple sclerosis and an affective disorder probably secondary to MS presented with multiple neurological signs and symptoms suggestive of active MS, most prominently akinetic mutism. Spinal fluid analysis and MRI supported a diagnosis of active MS. SPECT and EEG were nonspecifically abnormal. After 6 weeks of severe akinetic mutism refractory to one ECT treatment and trials of steroids and stimulants, the patient recovered spontaneously over a 2-month period. An acute brainstem lesion seen on MRI may explain this patient's akinetic mutism.

Disorders of executive functioning.

“…In severe cases that present with akinetic mutism, there is typically bilateral damage to the anterior cingulate cortex or associated basal ganglia circuits (Tibbetts, 2001) or, less frequently, bilateral lesions involving diencephalic and mesencephalic structures (Alexander, 2001;Cavanna et al, 2009). Additionally, apparent akinetic mutism has been observed in patients with multiple sclerosis (Scott et al, 1995) and advanced stages of Creutzfeldt-Jakob disease (Iwasaki et al, 2011;Kowalczyk et al, 2013). For a review, see Arnts et al (2020).…”