PR_288: Levodopa Trial on Akinetic Mutism With Bilateral Anterior Cerebral Artery Infarction: A Case Report

Abstract

Setting: Tertiary care rehabilitation hospital. Patient: A 71-year-old woman with bilateral anterior cerebral artery infarction. Case Description: The patient showed severe akinetic mutism. Initially, she responded only to noxious stimuli and exhibited neither spontaneous activity nor spontaneous voice. Her magnetic resonance imaging showed asymmetric bilateral anterior cerebral artery infarction, and positron emission tomography showed decreased uptake of 18F-fluorodeoxyglucose on both anterior cerebral artery territories, bilateral basal ganglia, and cerebellum. We started carbidopa and levodopa at 25 and 250mg daily and increased the daily dosage by adding 25 and 250mg every 3 days. Maintenance dosage was 100 and 1000mg. With levodopa, verbal output, responses to environment, spontaneous movement, and speech were improved. Assessment/Results: On the third day of carbidopa and levodopa at 25 and 250mg daily, she responded to sound and seemed to recognize her family. Her latency in responses became more rapid. When the dosage was increased to 75 and 750mg, spontaneous motor activity was shown. On 100 and 1000mg daily, she spoke monosyllabic word spontaneously. On 125 and 1250mg daily, she spoke disyllabic words. Because of subtle nausea, the dosage was maintained as 100 and 1000mg. Discussion: Regardless of various lesions, the etiology of akinetic mutism may be the injury to midbrain dopaminergic neurons or to their ascending pathways. Therefore we suggest that dopaminergic agents can improve akinetic mutism. Conclusions: Levodopa combined with carbidopa may be helpful to improve akinetic mutism.