Akinetic Mutism

Under the Akinetic Mutism the neurologist understands a severe drive disorder, which is characterized by persistent silence and immobility. This phenomenon usually occurs as a result of damage to the frontal lobe or the cingulate gyrus. The treatment, but also the prognosis, depends on the causes.

What is Akinetic Mutism?

The neurologist understands Akinetic Mutism to be a severe drive disorder characterized by persistent silence and immobility.

Akinetic mutism is a complex of neurological symptoms that manifest themselves in a serious drive disorder. Patients are persistently silent, which is also known as mutism. In addition, they do not make any movements and show no emotional involvement. Their immobility is also known as akinesia and externally gives the impression of paralysis.

However, their behavior is not due to physiological paralysis or disorders of the speech center, but rather they lack the drive to carry out all actions. The patient's perception is preserved. Although they are actually conscious, according to current research, a large part of what is happening does not reach their consciousness. The memory is not affected by the appearance, although the patients cannot remember most of the events during their illness.

causes

Akinetic mutism is usually preceded by an injury to the brain. Either the frontal lobe or the cingulate gyrus is damaged. The cingulate gyrus is part of the endbrain and belongs to the limbic system. These areas of the brain are particularly damaged in a stroke with bilateral occlusion of the cerebral artery. A traumatic brain injury can also damage the frontal lobe and the cingulate gyrus.

Other conceivable causes are tumors or a head of water. In these diseases, a pressure effect on the diencephalon can arise, which is expressed in akinetic mutism. Spongiform encephalopathies such as Creutzfeldt-Jakob disease can also produce the symptom complex of akinetic mutism. However, spongiform encephalopathy usually only has a corresponding effect at a very late stage.

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Symptoms, ailments & signs

A variety of neurological symptoms are grouped under the term akinetic mutism. The patients appear paralyzed, but are fully conscious. Even so, they do not show any 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 disorders of perception as the cause of this phenomenon.

According to recent research, this is not the case. In a conversation with sufferers of akinetic mutism, the neuroscientist Damasio found that the patients can perceive and understand the situation around them, but feel no drive to take action. The cingulate gyrus serves as an interface between cognition and emotion. This part of the brain plays an important role in motivation, which confirms Domasio's findings.

Diagnosis & course

As part of the diagnosis, if akinetic mutism is suspected, an MRI of the skull should be ordered. Inflammatory and infectious causes must be ruled out through a lumbar puncture and the laboratory diagnostic analysis of the cerebral fluid obtained in this way. Electroencephalography can be used to examine the electrical activity of the brain.

In the differential diagnosis, catatonia and Apallic syndrome must be taken into account. If there is akinetic mutism, the prognosis is relatively favorable. Full recovery is usually possible as long as the damage to the brain is not serious. An improvement can be expected even after months if the cause of the physiologically induced lack of drive can be treated satisfactorily.

Complications

Akinetic mutism is a neurological disease that manifests itself through silence, lack of drive, no emotional involvement and immobility similar to paralysis. Nevertheless, incidents seem to penetrate into consciousness, and those affected certainly have memories, provided they have overcome the period of illness. The symptom indicates damage to the frontal lobe, but it can also affect the belt curl of the limbic system.

It is caused by a traumatic brain injury, as a result of a tumor in the brain, a stroke and the congenital water head. Children show strong cognitive developmental delays and appear lethargic. The rapid medical clarification prevents lasting complications.

If adults show severe changes in personality that are associated with a loss of active participation as well as language and motor skills, medical help must be called in. The consequences of complications would be disorientation, loss of perception, reaction and knowledge as well as attacks of fever and complete inability to move. The course of recovery of akinetic mutism is conditioned by the cause of the outbreak.

With sufficient medical therapeutic inpatient care, there are full chances of recovery. If there are severe brain injuries as a result of an accident, complete healing is minimized. If a tumor is found, surgical removal and, if necessary, radiation therapy are carried out.

This can cause physical problems for the person concerned due to tolerance and hair loss. When laying a cerebrospinal fluid drainage, those affected by the head of water experience stress from the unfamiliar foreign body as well as the partial hair removal. In contrast, Creutzfeldt-Jakob patients have no prospects of recovery.

When should you go to the doctor?

As a rule, this disease does not represent a dangerous situation for the person concerned. The life expectancy is not changed as a rule, although the patient no longer speaks and usually no longer moves. In most cases, unfortunately, no treatment is possible. In most cases, this mutism is found directly in the hospital.

The person concerned is treated beforehand for damage to the brain. The mutism occurs directly through this damage and is determined and diagnosed directly. For this reason there is no need to see a doctor. Here, however, various therapies can be used to alleviate the complaints and symptoms. However, it cannot be predicted whether the disease will progress positively. However, if this mutism occurs over time, it may be a tumor. In any case, medical treatment is necessary if the symptoms progress and reduce the quality of life of the person concerned.

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Treatment & Therapy

Treatment for akinetic mutism is based on the cause. For example, if there is a tumor like the plexus papilloma, then the tumor is completely surgically removed. If the benign tumor is atypical or cannot be completely removed, additional radiation therapy is given. In the case of hydrocephalus, the intracranial pressure is reduced via a liquor drainage. A ventriculostomy is also possible. In the event of a stroke, it is important to wait and hope for the affected area to recover independently.

Immunosuppressive drugs may be given to avoid complications after a stroke. In cranial brain injuries of the second or higher degree, the increasing intracranial pressure must be counteracted by administering glucocorticoids. If sedation is required, this is achieved through drugs such as barbiturate, benzodiazepine or propofol. In this way, in addition to immobilization, there is a decrease in intracranial pressure.

If the intracranial pressure rises sharply despite these therapeutic measures, a relief craniectomy is also performed. As part of this surgical procedure, the surgeon removes parts of the skull to give the brain space to expand. When the swelling has subsided, the removed parts of the skull are reattached. In diseases like Creutzfeldt-Jakob disease, there is no chance of a cure. Death usually occurs within a few months, with patients remaining trapped in the terminal end-stage of the disease for some time.

Outlook & forecast

With this disease there is an extreme limitation of the patient in everyday life. The affected person cannot speak or move because the brain is severely damaged. These restrictions lead to an extreme reduction in quality of life and those affected are usually dependent on the help of other people in everyday life. The patient is still fully conscious, but cannot participate in the incident. Furthermore, it can also lead to perception disorders.

In this disease, treatment is always causal. The underlying disease must be treated, which in most cases is a tumor. However, it cannot be predicted here whether the disease will always progress positively. In some cases, treatment is not possible and the affected person has to spend their entire life with the symptoms.

After a stroke, medication may help relieve symptoms. In general, however, no universal prediction of the course of the disease is possible. Often the relatives of the patient are affected by the disease and sometimes suffer from psychological complaints.

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prevention

Akinetic mutism due to causes such as hydrocephalus or cranial brain trauma cannot be prevented. The risk of strokes can, however, be reduced by getting enough exercise, eating a healthy diet, reducing obesity and avoiding cigarettes and alcohol.

Aftercare

In most cases, there are no or very few follow-up measures available to those affected with this disease. Therefore, the affected person is primarily dependent on an early diagnosis with subsequent treatment so that there are no further complications or complaints. The earlier the disease is recognized and treated, the better the further course will usually be.

Therefore, early diagnosis is in the foreground with 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 must be ensured that the correct dosage and the correct frequency of use are adhered to.

If you have any questions or questions, you should always contact a doctor first so that there are no complications or other complaints. Furthermore, most patients with this disease depend 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 those affected is reduced by this disease.

You can do that yourself

The measures that patients with akinetic mutism can take themselves depend on the cause of the disease and the treatment strategy used. In principle, close monitoring is necessary in the case of tumor diseases. The patient should look out for unusual symptoms such as bleeding or tenderness and address them during the medical examination.

Furthermore, measures must be taken to alleviate the actual symptoms. Pressure pain can be alleviated by using cool pads or gentle massages in addition to drug therapy. In consultation with the doctor, various means from nature can be used. For example, the pain reliever devil's claw and the homeopathic remedy belladonna, which reduce inflammation and relieve pain, have proven themselves.

If neurological disorders arise as a result of the tumor disease, surgery is usually carried out. After an operation, 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 so that there are no wound healing disorders or scarring. Additional medical examinations are also indicated to ensure that the tumor has not recurred or metastasized.