Neurologists refer to akinetic mutism as a severe drive disorder characterized by persistent silence and immobility. Most often, this phenomenon occurs as a result of damage to the frontal brain or the cingulate gyrus. Treatment, as well as prognosis, depends on the causes.
What is akinetic mutism?
Neurologists define akinetic mutism as a severe drive disorder characterized by persistent silence and immobility. Akinetic mutism is a complex of neurological symptoms that manifest in a severe drive disorder. Patients are persistently silent, which is also referred to as mutism. They also do not perform any movements and show no emotional involvement. Their immobility is also called akinesia and externally gives the impression of paralysis. However, their behavior is not due to physiological paralysis or disorders of the speech center, but they lack the drive to perform all actions. The patients’ cognition remains intact. Although they are actually conscious, according to current research, however, much of what happens does not reach their consciousness. Memory is not affected by the phenomenon, although patients cannot recall most events during their disease period.
Causes
Akinetic mutism is usually preceded by an injury to the brain. Either the frontal brain or the cingulate gyrus is damaged. The cingulate gyrus is a portion of the terminal brain and is part of the limbic system. These areas of the brain take damage especially in a stroke with bilateral occlusion of the cerebral artery. Damage to the frontal brain and the cingulate gyrus can also occur in a traumatic brain injury. Other conceivable causes are tumors or hydrocephalus. These conditions may cause pressure on the diencephalon, resulting in akinetic mutism. Spongiform encephalopathies such as Creutzfeldt-Jakob disease can also produce the symptom complex of akinetic mutism. However, spongiform encephalopathies usually have a corresponding effect only at a very late stage.
Symptoms, complaints, and signs
A variety of neurologic symptoms are grouped under the term akinetic mutism. Patients appear paralyzed but are fully conscious. Yet they show no emotional involvement in the situations around them. They neither move independently nor can they be made to speak. For a long time, researchers suspected disorders of consciousness and perception as the cause of this phenomenon. According to recent research, however, this is not the case. The neuroscientist Damasio found out during a conversation with sufferers of akinetic mutism that the patients can certainly perceive and understand the situation around them, but do not feel any drive to action. The cingulate gyrus serves as an interface between cognition and emotion. This part of the brain has important roles in motivation, which reinforces Domasio’s findings.
Diagnosis and progression
As part of the diagnosis, an MRI of the skull should be ordered first and foremost if akinetic mutism is suspected. Inflammatory and infectious causes must be excluded by lumbar puncture and laboratory diagnostic analysis of the cerebrospinal fluid thus obtained. Electroencephalography can be used to examine the electrical activity of the brain. Differentially, catatonia and apallic syndrome in particular must be considered. If akinetic mutism is present, the prognosis is relatively favorable. Complete recovery is usually possible as long as the brain damage is not severe. Improvement can be expected even months later if the cause of the physiologically induced listlessness can be satisfactorily treated.
Complications
Akinetic mutism is a neurologic disorder characterized by silence, listlessness, no emotional involvement, and immobility similar to paralysis. Nevertheless, events appear to penetrate consciousness, and affected individuals do possess memories, provided they have overcome the period of illness.The symptom indicates damage to the frontal brain, but may also affect the girdle of the limbic system. It results from craniocerebral trauma, as a consequence of tumor involvement in the brain, stroke, as well as congenital hydrocephalus. Children show severe cognitive developmental delays and appear lethargic. Rapid medical clarification prevents permanent complications. If adults show severe changes of character, which are accompanied by loss of active participation as well as speech and motor skills, medical help must be called in. The complication consequences would be disorientation, loss of perception, reaction and knowledge, as well as fever episodes and complete immobility. The course of recovery from akinetic mutism is conditioned by the cause of the onset. With sufficient medical therapeutic inpatient care, there is a full chance of recovery. If there are severe brain injuries due to an accident, a complete recovery is minimized. If there are tumor findings, surgical removal and possible radiation therapy are performed. This can cause physical problems for the affected person due to tolerance and hair loss. If a CSF drainage is installed, hydrocephalus sufferers experience stress due to the unfamiliar foreign body as well as the partial hair removal. Creutzfeldt-Jakob patients, on the other hand, possess no chance of recovery.
When should you see a doctor?
As a rule, this disease does not present a dangerous situation for the affected person. It also does not usually alter life expectancy, although the patient no longer speaks and usually does not move. In most cases, unfortunately, no treatment is possible. In most cases, this mutism is already diagnosed directly in the hospital. The affected person is treated before due to a damage of the brain. The mutism occurs directly due to this damage and is directly detected and diagnosed. For this reason, it is not necessary to see a doctor. However, various therapies can be used to alleviate the complaints and symptoms. However, it cannot be predicted whether the disease will progress positively. However, should this mutism occur in the course of time, it may be a tumor. In this case, medical treatment is definitely necessary if the symptoms progress and reduce the quality of life of the affected person.
Treatment and therapy
Treatment of akinetic mutism depends on the cause. For example, if there is a tumor such as plexus papilloma, then the tumor is removed completely by surgery. If the benign tumor is atypical or cannot be completely removed, additional radiation therapy is given. If hydrocephalus is present, cerebral pressure is reduced via cerebrospinal fluid drainage. Ventriculostomy is also a possibility. In case of a stroke, it is important to wait and hope for an independent recovery of the affected area. Immunosuppressive drugs may be given to prevent complications after a stroke. In cases of second-degree or even higher craniocerebral trauma, the rising intracranial pressure must be counteracted by the administration of glucocorticoids. If sedation is necessary, this is achieved by drugs such as barbiturate, benzodiazepine or propofol. In this way, a reduction in intracranial pressure occurs in addition to immobilization. If the intracranial pressure rises sharply despite these therapeutic measures, a relieving craniectomy is also performed. During this surgical procedure, the operating surgeon removes portions of the skull to give the brain room to spread. When the swelling has gone down, the removed parts of the skull are reattached. There is no cure for conditions such as Creutzfeldt-Jakob disease. Death usually occurs within a few months, with patients remaining trapped in the terminal end-stage of the disease for some time.
Outlook and prognosis
In this disease, there is extreme limitation of the patient in daily life. The affected person cannot speak or move as well because of severe damage to the brain. These limitations lead to an extreme reduction in the quality of life, and the affected person is usually dependent on the help of other people in everyday life. The patient is still fully conscious, but cannot participate in the events themselves.Furthermore, perceptual disorders may also occur. In this disease, treatment is always causal. The underlying disease must be treated, which in most cases is a tumor. However, it is not possible to predict whether the course of the disease will be positive in every case. In some cases, no treatment is possible and the affected person must spend his entire life with the symptoms. After a stroke, medication may be able to alleviate the symptoms. In general, however, no universal prediction of the course of the disease is possible. Often, the patient’s relatives are also affected by the disease and sometimes suffer from psychological discomfort as a result.
Prevention
Acinetic mutism due to causes such as hydrocephalus or traumatic brain injury cannot be prevented. However, the risk of stroke can be reduced by getting enough exercise, eating a healthy diet, reducing obesity, and avoiding cigarettes and alcohol.
Follow-up
In most cases, there are no or very few aftercare measures available to the person affected by this disease. Therefore, the affected person is primarily dependent on an early diagnosis with subsequent treatment, so that there are no further complications or discomfort. The earlier the disease is detected and treated, the better the further course of the disease usually is. Therefore, early diagnosis is the most important factor in this disease. The treatment itself is usually carried out with the help of radiation therapy, although most of those affected are also dependent on taking medication. When taking medication, it is important to ensure that the correct dosage and also the correct frequency are observed. In case of ambiguities or questions, a doctor should always be contacted first, so that complications or other complaints do not arise. Furthermore, most patients with this disease are dependent on the support and care of their own family and friends. Psychotic support is also very useful to prevent such complaints. In some cases, the life expectancy of the affected person is reduced by this disease.
This is what you can do yourself
The actions that patients suffering from akinetic mutism can take themselves depend on the cause of the disorder and the particular treatment strategy. In general, close monitoring is necessary in tumor disease. Patients themselves should watch out for unusual symptoms such as bleeding or pressure pain and address these during the medical examination. Furthermore, measures must be taken to alleviate the actual symptoms. Pressure pain can be relieved by cool compresses or gentle massages to accompany drug therapy. In consultation with the doctor, various natural remedies can be used. For example, the painkilling devil’s claw and the homeopathic remedy belladonna, which reduces inflammation and relieves pain, have proven effective. If neurological disorders develop as a result of the tumor disease, surgery is usually performed. After surgery, the patient needs rest. The surgical wound is treated in the hospital for the first few days and must be carefully cared for at home to prevent wound healing disorders or scarring. Accompanying further medical examinations are indicated to ensure that the tumor has not recurred or metastasized.