Akinetic Mutism
| Classification according to ICD-10 | |
|---|---|
| R41.8 | Other and unspecified symptoms affecting cognition and awareness |
| ICD-10 online (WHO version 2019) | |
The akinetic mutism is a neurological syndrome , which by a heavy failure of the actuator is indicated. The person concerned is awake and has no paralysis . However, he does not move himself ( akinesia ), does not speak ( mutism ) and does not show any emotions, as there is no drive for this. Perception and memory are usually not impaired.
causes
- Damage to the frontal lobe or cingulate gyrus , for example from bilateral occlusion of the anterior cerebral artery (stroke) or a traumatic brain injury
- Pressure effect on the diencephalon , especially by tumors (for example, choroid plexus papilloma ) or a hydrocephalus
- Later stage of spongiform encephalopathies such as Creutzfeldt-Jakob disease .
Diagnosis
For an exact assessment and clarification of the cause of the syndrome, a magnetic resonance tomography of the head and the derivation of an electroencephalogram are necessary, often also an examination of the cerebrospinal fluid to rule out an inflammatory disease. It is particularly important to differentiate between an Apallic syndrome , a locked-in syndrome or a catatonia .
forecast
The further development depends on the causal disease. Significant recovery is therefore still possible even after months, for example after treatment of hydrocephalus ("water head") or as part of recovery from a traumatic brain injury.
Neuropsychological Aspects
Neuropsychological findings indicate that the anterior cingulate gyrus, which is affected by this disease, plays an important role in volition: this brain region forms the front part of a cerebral convolutions, which is located like a sickle on the inner surface of the cortex, and from many authors consider it to be part of the frontal lobe. In addition to its importance in the selection of actions, it is an interface between emotion and cognition.
António Damásio dealt with such patients for years. One patient who awoke from this state reported that she was enigmatic for months of silence and immobility. Contrary to what a casual observer might have thought, her mind hadn't been locked like a prison. In fact, there wasn't much left of her spirit. She had no memory of any particular experience during the long period of silence. She had never felt fear or anxiety, never felt the need to communicate. Damasio emphasizes that this patient did not suffer from any of this. There were no emotional reactions. What she lacked was obviously any drive, any motivation to take action. As she said herself, it wasn't because she didn't understand what was going on around her. Rather, she didn't want to do or say anything. Francis Crick concluded from this description that the woman had lost her will.
