Akinetic mutism

Wolff V, Saint Maurice JP, Ducros A et al (2002) Akinetic mutism and anterior bicerebral infarction due to abnormal distribution of the anterior cerebral artery. Rev Neurol (Paris) 158 377-380... 

This case shows that, regardless of the formulation of amphotericin, severe neurological adverse effects can occur, in particular in patients who receive large dosages of amphotericin after cranial irradiation. A clinical syndrome of akinetic mutism, incontinence, and parkinsonism has been described in patients who received large doses of amphotericin deoxycholate in association with central nervous system irradiation or infection (67). 

Altered consciousness is a major adverse effect of baclofen, because of its GABA-mimetic effects. While this reflects global nervous system depression, other adverse effects, such as seizures and dyskinesias, are probably better explained by selective effects on different brain areas. A case of akinetic mutism associated with baclofen might be an example of this (1). 

The authors explained that akinetic mutism occurs when bilateral frontal lobe or diencephahc-mesencephalic dysfunction interrupts the limbic circuitry. As symptoms were observed immediately after the start of treatment and resolved completely after withdrawal, the condition was probably caused by baclofen. It is not known why baclofen in this case impaired neuronal activity specifically in these areas. The authors found only one previous report describing the case of a 57-year-old woman with end-stage renal insufficiency, who developed akinetic mutism after a single dose of baclofen (2). In this case, the sjmptoms resolved after dialysis. Therefore, adverse effects of baclofen should be suspected if neuropsychiatric symptoms occur after baclofen treatment has been started. Electroencephalography and computerized tomography may be necessary to exclude other causes. 

Rubin DI, So EL. Reversible akinetic mutism possibly induced by baclofen. Pharmacotherapy 1999 19(4) 468-70. 

Parmar MS. Akinetic mutism after baclofen. Ann Intern Med 1991 115(6) 499-500. 

When neurological symptoms occur in patients taking tacrolimus they are very similar to those seen in patients taking ciclosporin, with more frequent insomnia, tremor, and headaches, but a similar rate of severe neurological adverse effects, such as acute psychosis, peripheral neuropathy, seizures, encephalopathy, coma, and paralysis. Persistent speech disorders (dysarthria, apraxia, expressive aphasia, akinetic mutism), and visual blurring can also occur (SEDA-21, 391) (SEDA-22, 420) (24). 

Smith JS, Brierley H, Brandon S Akinetic mutism with recovery after repeated carbon monoxide poisoning. Psychol Med 1 172-177,1971 Sohn YH, Jeong Y, Kim HS, et al The brain lesion responsible for parkinsonism after carbon monoxide poisoning. Arch Neurol 57 1214-1218, 2000 Strecker EA, Taft AE, Willey GF Mental sequelae of carbon monoxide poisoning with reports of autopsy in two cases. Archives of Neurology and Psychiatry 17 552-555, 1927... 

Akinetic mutism has been reported in a 66-year-old man who was given intravenous methylprednisolone and tacrolimus after Uver transplantation [75 ]. On day 3 he developed acute onset mutism, akinesia, and waxy rigidity of passive limb movements. The serum tacrolimus concentration was 21 pg/1. Tacrolimus was replaced with ciclosporin and mycophenolate mofetil, and his symptoms resolved completely over the next few days. 

Sierra-Hidalgo F, Martmez-Salio A, Mor-eno-Garcfa S, de Pablo-Femandez E, Cor-reas-Callero E, Ruiz-Morales J. Akinetic mutism induced by tacrolimus. Clin Neuropharmacol 2009 32(5) 293-4. 

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