Akinetic Mutism (Coma Vigil)

A syndrome characterized by a silent and inert state without voluntary motor activity despite preserved sensorimotor pathways and vigilance. Bilateral FRONTAL LOBE dysfunction involving the anterior cingulate gyrus and related brain injuries are associated with this condition. This may result in impaired abilities to communicate and initiate motor activities. (From Adams et al., Principles of Neurology, 6th ed, p348; Fortschr Neurol Psychiatr 1995 Feb;63(2):59-67)

Also Known As:

Networked: 98 relevant articles (16 outcomes, 4 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Stroke (Strokes)
2.	Tremor (Tremors)
3.	Muscle Rigidity
4.	Dyskinesias (Dyskinesia)
5.	Neurologic Manifestations (Neurological Manifestations)

Experts

1.	Iwasaki, Yasushi: 5 articles (12/2021 - 01/2012)
2.	Yoshida, Mari: 4 articles (12/2021 - 06/2014)
3.	Ito, Masumi: 3 articles (12/2021 - 01/2012)
4.	Kitamoto, Tetsuyuki: 3 articles (12/2021 - 06/2014)
5.	Mori, Keiko: 3 articles (12/2021 - 01/2012)
6.	Mimuro, Maya: 3 articles (06/2016 - 06/2014)
7.	Akagi, Akio: 2 articles (12/2021 - 10/2015)
8.	Tatsumi, Shinsui: 2 articles (06/2016 - 06/2014)
9.	Mariën, Peter: 2 articles (10/2013 - 01/2013)
10.	Verhoeven, Jo: 2 articles (10/2013 - 01/2013)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Akinetic Mutism:

1.	Bromocriptine (Parlodel)FDA LinkGeneric 01/16/2017 - "[Bromocriptine: could it be the cure for post-surgical akinetic mutism?]" 09/01/2007 - "Postoperatively, the patient developed akinetic mutism, but her condition improved after administration of bromocriptine. " 12/01/2003 - "This patient developed akinetic mutism postoperatively, which improved with bromocriptine. " 04/01/2000 - "The akinetic mutism and the PSP-like syndrome were remarkably improved with bromocriptine." 08/01/2013 - "After a repeated course of dilated and slit-like ventricle, he gradually presented a disturbance of consciousness, which was recovered by the use of bromocriptine, suggesting akinetic mutism. "
2.	Dopamine Agonists (Dopamine Agonist)IBA 11/01/1981 - "Akinetic mutism from hypothalamic damage: successful treatment with dopamine agonists." 05/01/2007 - "We describe a 72-year-old man who developed akinetic mutism following a cerebrovascular accident involving his right internal watershed area and responded well to dopaminergic agonists. " 02/01/1999 - "Akinetic mutism after fourth ventricle choroid plexus papilloma: treatment with a dopamine agonist." 08/01/2003 - "Postoperatively, the patient developed the clinical syndrome of akinetic mutism, but her condition improved after the administration of the dopaminergic agonist bromocriptine. " 01/01/2013 - "Akinetic mutism resolved after treatment with a non-ergoline dopamine-agonist but CCAS persisted during longitudinal follow-up. "
3.	Levodopa (L Dopa)FDA LinkGeneric 01/01/2023 - "Although akinetic mutism generally has a poor prognosis, it may respond to Levodopa with a better outcome." 07/01/2000 - "Akinetic mutism from frontal lobe damage responding to levodopa." 01/01/2023 - "Case report: Levodopa-responsive parkinsonism with akinetic mutism after ventriculo-peritoneal shunt." 01/01/2017 - "Akinetic mutism reversibility after L-dopa therapy in unilateral left anterior cerebral artery infarction." 10/01/1987 - "Shortly after administration of levodopa and trihexyphenidyl, akinetic mutism began to improve, but upward gaze palsy was not affected. "
4.	Zolpidem (Ambien)FDA LinkGeneric 07/01/2007 - "We conducted a randomized, double-blind, placebo-controlled, single-patient (N = 1) trial to evaluate the efficacy of zolpidem in a 48-year-old woman with an akinetic mutism. "
5.	Trihexyphenidyl (Artane)FDA LinkGeneric 05/01/1989 - "Cases involving two patients who presented post-traumatic prolonged disturbance of consciousness (PTPDC), namely akinetic mutism, and recovered from it after treatment with trihexyphenidyl were reported. " 04/01/1981 - "A case of central anticholinergic syndrome due to overdosage of trihexyphenidyl hydrochloride presenting as septal akinetic mutism with unequally dilated pupils is discussed in reference to similar presentation in animals and possible clinical application." 10/01/1987 - "Shortly after administration of levodopa and trihexyphenidyl, akinetic mutism began to improve, but upward gaze palsy was not affected. " 10/01/1987 - "A case of akinetic mutism was reported with reference to a marked improvement by levodopa, bromocriptine and trihexyphenidyl. " 10/01/1987 - "[Akinetic mutism from recurrent hydrocephalus: successful treatment with levodopa, bromocriptine and trihexyphenidyl]."
6.	BaclofenFDA LinkGeneric 04/01/1999 - "To our knowledge, this is the first reported case of baclofen-induced akinetic mutism in a patient with normal renal function. " 04/01/1999 - "A 76-year-old man developed akinetic mutism after 3 days of receiving low-dosage baclofen. " 04/01/1999 - "Reversible akinetic mutism possibly induced by baclofen." 09/15/1991 - "Akinetic mutism after baclofen." 01/01/2013 - "In the third week of hospitalization, while still in a state of akinetic mutism, she developed incessant bruxism which responded favorably to a GABA receptor agonist (baclofen). "
7.	Cyclosporine (Ciclosporin)FDA LinkGeneric 12/01/1990 - "In these patients the time course of the akinetic mutism and extrapyramidal syndrome, which developed in the absence of any other identifiable cause, suggests cyclosporin A was the precipitating factor. " 12/01/1990 - "Three patients developed akinetic mutism on the third day after the introduction of intravenous cyclosporin A, given for immunosuppression after liver transplantation. " 12/01/1990 - "Cyclosporin-associated akinetic mutism and extrapyramidal syndrome after liver transplantation." 12/01/1990 - "One patient in addition developed a florid orofacial dyskinesia, which resolved completely, as did the akinetic mutism, after withdrawal of cyclosporin. " 09/01/2009 - "Serum levels of tacrolimus were 20.8 ng/mL, so it was substituted by cyclosporine and mycophenolate mofetil with progressive and complete recovery of akinetic mutism during the following days. "
8.	GABA Agonists (GABA Receptor Agonists)IBA 01/01/2013 - "In the third week of hospitalization, while still in a state of akinetic mutism, she developed incessant bruxism which responded favorably to a GABA receptor agonist (baclofen). "
9.	Metoprolol (Toprol-XL)FDA LinkGeneric 06/01/1995 - "The patient developed a syndrome of akinetic mutism that improved after administration of bromocriptine and metoprolol."
10.	Magnesium Sulfate (Sulfate, Magnesium)FDA LinkGeneric 01/01/2012 - "She had rapid resolution of akinetic mutism with intravenous magnesium sulfate as well as improvement in her other associated neurologic symptoms. " 01/01/2012 - "The case report suggests the use of intravenous magnesium sulfate as an acute treatment for the akinetic mutism associated with delayed post-hypoxic leukoencephalopathy. " 01/01/2012 - "Rapid resolution of akinetic mutism in delayed post-hypoxic leukoencephalopathy with intravenous magnesium sulfate."

Therapies and Procedures

1.	Therapeutics 06/01/2005 - "IFN-alpha therapy dramatically induced remission of disease and greatly improved quality of life for 7-8 years, but this was followed by severely deterioration with decorticate posturing and akinetic mutism. " 12/01/2021 - "In general, patients reach an akinetic mutism state within a few months of disease onset and die soon after if supportive therapies are not administered. " 08/01/2008 - "These new lesions disappeared spontaneously and akinetic mutism regressed without any specific therapy. " 07/01/1998 - "One patient developed neurologic toxicity with akinetic mutism, and died following therapy. " 07/01/2002 - "His symptoms and signs deteriorated in several days despite intensive antithrombotic therapy, resulting in right hemiparesis, akinetic mutism, memory disturbance, change of personality, urinary incontinence, forced grasping, and starting delay of speech and motion. "
2.	Ventriculoperitoneal Shunt 03/01/1976 - "After suboccipital exploratory craniotomy and ventriculo-peritoneal shunt akinetic mutism improved gradually, and he was discharged on foot after 7 months. " 01/01/2023 - "Parkinsonism and akinetic mutism (AM) following ventriculo-peritoneal shunt (VPS) without underdrainage used to be considered rare, but may be underdiagnosed in daily clinical practice. " 01/01/2023 - "Case report: Levodopa-responsive parkinsonism with akinetic mutism after ventriculo-peritoneal shunt."
3.	Intramuscular Injections 01/01/2023 - "Intramuscular injection of biperiden improved muscle rigidity, tremors, dysphagia, and akinetic mutism. "
4.	Craniotomy 03/01/1976 - "After suboccipital exploratory craniotomy and ventriculo-peritoneal shunt akinetic mutism improved gradually, and he was discharged on foot after 7 months. "
5.	Enteral Nutrition (Feeding, Tube) 06/01/2014 - "We speculate that the most crucial factor of the prolonged survival period of Japanese sCJD cases, particularly in the PE-type, is that the introduction of tube-feeding in the akinetic mutism state leads to the stabilization of the patient's general condition." 12/01/2021 - "Although the patient remained stable with tube feeding for more than 2 years after reaching the akinetic mutism state, he died because of central respiratory failure 30 months after disease onset. " 10/15/2015 - "Because the total disease duration increased in cases with a slowly progressive clinical course as a natural outcome, we concluded that the most crucial factor contributing to the prolonged survival of Japanese sCJD patients was tube feeding once the akinetic mutism state had been reached." 01/01/2012 - "We speculate that nasal-tube feeding is the crucial factor that results in the prolonged disease duration of prion disease patients in the akinetic mutism state." 04/01/2007 - "At the age of 34, he became akinetic mutism after nonconvulsive status epilepticus and needed enteral nutrition through a nasogasrtic tube. "