Case Report: Treatment of Akinetic Mutism after Unilateral Anterior Cerebral Artery Infarction with Methylphenidate and Levodopa/Benserazide.

IF 0.6 Q4 CLINICAL NEUROLOGY Case Reports in Neurology Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI:10.1159/000539033

Julia Zibold, Moritz Luigi Schmidbauer, Johannes Wischmann, Konstantinos Dimitriadis

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Abstract

Introduction: Akinetic mutism is a severe state of impaired volition that can result from a stroke. Its therapeutic evidence relies on single case reports that used atomoxetine or levodopa with variable latency and efficacy.

Case presentation: We present the case of a 54-year-old woman who developed akinetic mutism after infarction in the territory of the right anterior cerebral artery, successfully treated with methylphenidate and levodopa/benserazide. Clinical examination showed a patient lacking any spontaneous speech and movement while opening her eyes and fixating. Suspecting akinetic mutism after a comprehensive diagnostic work-up, we started an individual therapy attempt with methylphenidate 10 mg and levodopa/benserazide 100/25 mg twice daily. Both drugs affect the dopaminergic and noradrenergic transmission in the frontal-subcortical circuit, compromised in akinetic mutism. We saw rapid and sustained improvement in her volitional actions, devoid of side effects. Finally, the patient was actively communicating and moving her limbs.

Conclusion: We discuss the patient's favorable clinical course in response to the synergistic combination of methylphenidate and levodopa/benserazide, emerging as a promising treatment strategy, and provide a brief literature review of treatment options in akinetic mutism following stroke.

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病例报告：用哌醋甲酯和左旋多巴/苄丝肼治疗单侧大脑前动脉梗塞后的动眼神经障碍。

导言激越性缄默症是一种严重的意志障碍，可由中风引起。其治疗证据依赖于使用阿托西汀或左旋多巴的单个病例报告，其潜伏期和疗效各不相同：我们介绍了一例 54 岁女性患者的病例，她在右侧大脑前动脉区域发生脑梗塞后出现运动性缄默症，使用哌醋甲酯和左旋多巴/苄丝肼治疗后获得成功。临床检查显示，患者在睁眼和凝视时没有任何自发言语和动作。经过全面诊断后，我们怀疑患者患有动眼神经缄默症，于是开始尝试使用哌醋甲酯 10 毫克和左旋多巴/苄丝肼 100/25 毫克进行个体治疗，每天两次。这两种药物都会影响多巴胺能和去甲肾上腺素能在额叶-皮层下回路的传递，而动情性缄默症则会受到这种影响。我们发现她的意志行动得到了迅速而持续的改善，而且没有副作用。最后，患者开始积极交流并活动四肢：我们讨论了该患者对哌醋甲酯和左旋多巴/苯塞拉嗪的协同组合疗法的良好临床疗效（这是一种很有前景的治疗策略），并对中风后运动性缄默症的治疗方案进行了简要的文献综述。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Case Reports in Neurology Medicine-Neurology (clinical)

CiteScore

1.50

自引率

0.00%

发文量

审稿时长

14 weeks

期刊介绍： This new peer-reviewed online-only journal publishes original case reports covering the entire spectrum of neurology. Clinicians and researchers are given a tool to disseminate their personal experience to a wider public as well as to review interesting cases encountered by colleagues all over the world. To complement the contributions supplementary material is welcomed. The reports are searchable according to the key words supplied by the authors; it will thus be possible to search across the entire growing collection of case reports with universally used terms, further facilitating the retrieval of specific information. Following the open access principle, the entire contents can be retrieved at no charge, guaranteeing easy access to this valuable source of anecdotal information at all times.