Encyclopedia of Clinical Neuropsychology

2011 Edition
| Editors: Jeffrey S. Kreutzer, John DeLuca, Bruce Caplan

Akinetic Mutism

  • Michael S. Mega
Reference work entry
DOI: https://doi.org/10.1007/978-0-387-79948-3_1876

Synonyms

A spectrum of motivational impairment has abulia at one end and akinetic mutism at the other. Coma vigil is not akinetic mutism; it arises when a comatose patient regains the sleep-wake cycle, eyes open during the day and closed during sleep at night, usually after 2 weeks of a brain lesion that produces irreversible coma. Coma vigil is also referred to as a persistent vegatative state. When brain lesions disconnect all descending motor output but preserve conscious awareness the patient is said to be locked in. In akinetic mutism, patients still respond to their internal and external environment – and thus are not in coma, and they are not locked in since they can accomplish motor output, given sufficient motivation.

Short Description or Definition

The fully formed akinetic mute state usually results from bilateral anterior cingulate lesions (Fig. 1). Patients are profoundly apathetic, incontinent, and akinetic. They do not initiate eating or drinking and if speech occurs,...
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References and Readings

  1. Baer, L., Rauch, S. L., Ballantine, H. T., Martuza, R., Cosgrove, R., Cassem, E., et al. (1995). Cingulotomy for intractable obsessive-compulsive disorder: prospective long-term follow-up of 18 patients. Archives of General Psychiatry, 52, 384–392.PubMedGoogle Scholar
  2. Brefel-Courbon, C., Payoux, P., Ory, F., Sommet, A., Slaoui, T., Raboyeau, G., et al. (2007). Clinical and imaging evidence of zolpidem effect in hypoxic encephalopathy. Annals of Neurology, 62(1), 102–105.PubMedGoogle Scholar
  3. Damasio, A. R., & Van Hoesen, G. W. (1983). Focal lesions of the limbic frontal lobe. In K. M. Heilman & P. Satz (Eds.), Neuropsychology of human emotion (pp. 85–110). New York: Guilford.Google Scholar
  4. Grunsfeld, A. A., & Login, I. S. (2006). Abulia following penetrating brain injury during endoscopic sinus surgery with disruption of the anterior cingulate circuit: case report. BMC Neurology, 6, 4.PubMedCentralPubMedGoogle Scholar
  5. Hay, P., Sachdev, P., Cumming, S., Smith, J. S., Lee, T., Kitchener, P., et al. (1993). Treatment of obsessive-compulsive disorder by psychosurgery. Acta Psychiatrica Scandinavica, 87, 197–207.PubMedGoogle Scholar
  6. Laplane, D., Levasseur, M., Pillon, B., Dubois, B., Baulac, M., Mazoyer, B., et al. (1989). Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions. Brain: A Journal of Neurology, 112, 699–725.Google Scholar
  7. Mega, M. S., & Cohenour, R. C. (1997). Akinetic mutism: a disconnection of frontal-subcortical circuits. Neurology, Neuropsychology, and Behavioral Neurology, 10, 254–259.Google Scholar
  8. Mega, M. S., & Cummings, J. L. (1994). Frontal subcortical circuits and neuropsychiatric disorders. Journal of Neuropsychiatry and Clinical Neurosciences, 6, 358–370.PubMedGoogle Scholar
  9. Mori, E., Yamashita, H., Takauchi, S., & Kondo, K. (1996). Isolated athymhormia following hypoxic bilateral pallidal lesions. Behavioral Neurology, 9, 17–23.Google Scholar
  10. Nagaratnam, N., Nagaratnam, K., Ng, K., & Diu, P. (2004). Akinetic mutism following stroke. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia, 11(1), 25–30.Google Scholar
  11. Pribram, K. H., & Fulton, J. F. (1954). An experimental critique of the effects of anterior cingulate ablations in monkey. Brain: A Journal of Neurology, 77, 34–44.Google Scholar
  12. Psarros, T., Zouros, A., & Coimbra, C. (2003). Bromocriptine-responsive akinetic mutism following endoscopy for ventricular neurocysticercosis. Case report and review of the literature. Journal of Neurosurgery, 99(2), 397–401.PubMedGoogle Scholar
  13. Spiegel, D. R., Casella, D. P., Callender, D. M., & Dhadwal, N. (2008). Treatment of akinetic mutism with intramuscular olanzapine: a case series. Journal of Neuropsychiatry and Clinical Neurosciences, 20(1), 93–95.PubMedGoogle Scholar
  14. Tow, P. M., & Whitty, C. W. M. (1953). Personality changes after operations of the cingulate gyrus in man. Journal of Neurology, Neurosurgery, and Psychiatry, 16, 186–193.PubMedCentralPubMedGoogle Scholar
  15. Ure, J., Faccio, E., Videla, H., Caccuri, R., Giudice, F., Ollari, J., et al. (1998). Akinetic mutism: a report of three cases. Acta Neurologica Scandinavica, 98(6), 439–444.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Michael S. Mega
    • 1
  1. 1.Cognitive Assessment ClinicProvidence Brain Institute, Providence Health SystemPortlandUSA