WordNet

the condition of being unable or unwilling to speak; "her muteness was a consequence of her deafness" (同)muteness

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/31 11:52:16」(JST)

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Akinetic mutism is a medical term describing patients tending neither to move (akinesia) nor speak (mutism). Akinetic mutism was first described in 1941 by Cairns et al. as a mental state where patients lack the ability to move or speak.^[1] However, their eyes may follow their observer or be diverted by sound.^[1] Patients lack most motor functions such as speech, facial expressions, and gestures, but demonstrate apparent alertness.^[2] They exhibit reduced activity and slowness, and can speak in whispered monosyllables.^[1]^[3] Patients often show visual fixation on their examiner, move their eyes in response to an auditory stimulus, or move after often repeated commands.^[1]^[2] Patients with akinetic mutism are not paralyzed, but lack the will to move.^[1] Many patients describe that as soon as they ‘will’ or attempt a movement, a ‘counter-will’ or ‘resistance’ rises up to meet them.^[4]

1 Description
- 1.1 Frontal akinetic mutism
- 1.2 Mesencephalic akinetic mutism
2 Symptoms
3 Causes
- 3.1 Frontal lobe damage
- 3.2 Thalamic stroke
- 3.3 Ablation of cingulate gyrus
- 3.4 Other
4 Diagnosis and treatment
- 4.1 Magnesium sulfate
- 4.2 Cyst puncture
- 4.3 Dopamine agonist therapy
5 History
6 See also
7 References

Description

Frontal akinetic mutism can occur after a frontal lobe injury

The mesencephalic form of akinetic mutism occurs in the midbrain (4)

Akinetic mutism varies across all patients. Its form, intensity, and clinical features correspond more closely to its functional anatomy rather than to its pathology. However, akinetic mutism most often appears in two different forms: frontal and mesencephalic.^[2]

Frontal akinetic mutism

Akinetic mutism can occur in the frontal region of the brain and occurs because of bilateral frontal lobe damage. Akinetic mutism as a result of frontal lobe damage is clinically characterized as hyperpathic.^[5] It occurs in patients with bilateral circulatory disturbances in the supply area of the anterior cerebral artery.^[2]

Mesencephalic akinetic mutism

Akinetic mutism can also occur as a result of damage to the mesencephalic region of the brain. Mesencephalic akinetic mutism is clinically categorized as somnolent or apathetic akinetic mutism.^[5] It is characterized by vertical gaze palsy and ophthalmoplegia. This state of akinetic mutism varies in intensity, but it is distinguished by drowsiness, lack of motivation, hyper-somnolence, and reduction in spontaneous verbal and motor actions.^[2]^[5]

Symptoms

Symptoms of akinetic mutism progress over time.^[2] The occurrence of akinetic mutism takes place approximately four months after the symptoms first appear.^[2]

Lack of motor function (but not paralysis)^[1]
Lack of speech ^[1]
Apathy^[6]
Slowness^[6]
Disinhibition^[3]

Causes

Many cases of akinetic mutism have occurred after a thalamic stroke.

Akinetic mutism can be caused by a variety of things. It often occurs after brain injury or as a symptom of other diseases.

Frontal lobe damage

Akinetic mutism is often the result of severe frontal lobe injury in which the pattern of inhibitory control is one of increasing passivity and gradually decreasing speech and motion.

Thalamic stroke

Many cases of akinetic mutism occur after a thalamic stroke.^[3] The thalamus helps regulate consciousness and alertness.

Ablation of cingulate gyrus

Another cause of both akinesia and mutism is ablation of the cingulate gyrus. Destruction of the cingulate gyrus has been used in the treatment of psychosis. Such lesions result in akinesia, mutism, apathy, and indifference to painful stimuli.^[7] The anterior cingulate cortex is thought to supply a "global energizing factor" that stimulates decision making.^[8] When the anterior cingulate cortex is damaged, it can result in akinetic mutism.

Other

Akinetic mutism is a symptom during the final stages of Creutzfeldt-Jakob Disease (a rare degenerative brain disease) and can help diagnose patients with this disease.^[2]^[9] It can also occur in a stroke that affects both anterior cerebral artery territories. Another cause is neurotoxicity due to exposure to certain drugs such as tacrolimus and cyclosporine.

Other causes of akinetic mutism are as follows:

Respiratory arrest and cerebral hypoxia ^[6]
Acute cases of encephalitis lethargica^[3]
Meningitis^[3]
Hydrocephalus^[3]
Trauma^[3]
Tumors^[3]
Aneurysms ^[3]
Olfactory groove meningioma
Cyst in third ventricle ^[1]
Toxical lesions and infections of central nervous system ^[10]
Delayed post-hypoxic leukoencephalopathy (DPHL) ^[6]
Creutzfeldt-Jakob Disease (mesencephalic form) ^[2]

Diagnosis and treatment

Akinetic mutism can be misdiagnosed as depression, delirium, or locked-in syndrome, all of which are common following a stroke.^[3] Patients with depression can experience apathy, slurring of speech, and body movements similar to akinetic mutism. Similarly to akinetic mutism, patients with locked-in syndrome experience paralysis and can only communicate with their eyes.^[3] Correct diagnosis is important to ensure proper treatment. A variety of treatments for akinetic mutism have been documented, but treatments vary between patients and cases.

Magnesium sulfate

Treatments using intravenous magnesium sulfate have shown to reduce the symptoms of akinetic mutism. In one case, a 59 year old woman was administered intravenous magnesium sulfate in an attempt to resolve her akinetic mutism. The patient was given 500 mg of magnesium every eight hours, and improvement was seen after 24 hours. She became more verbal and attentive, and treatment was increased to 1000 mg every eight hours as conditions continued to improve.^[11]

Cyst puncture

As seen in the case of Elsie Nicks, the puncture or removal of a cyst causing akinetic mutism can relieve symptoms almost immediately. However, if the cyst fills up again, the symptoms can reappear.^[1]

Dopamine agonist therapy

Symptoms of akinetic mutism suggest a possible presynaptic deficit in the nigrostriatal pathway, which transmits dopamine. Some patients with akinetic mutism have shown to improve with levodopa or dopamine agonist therapy,^[12] or by repleting dopamine in the motivational circuit with stimulants, antidepressants, or agonists such as bromocriptine or amantadine.^[6]

Other treatments include amantadine, carbidopa-levodopa, donepezil, memantine, and oral magnesium oxide.^[6]^[11]

History

Fourteen-year-old Elsie Nicks was the first patient to be diagnosed with akinetic mutism by Cairns in 1941. She suffered from severe headaches her entire life and was eventually given morphia to help with treatment. She began to enter a state of akinetic mutism, experiencing apathy and loss of speech and motor control. A cyst on her right lateral ventricle was tapped, and as soon as the needle advanced toward the cyst, she let out a loud noise and was able to state her name, age, and address. After her cyst was emptied, she regained her alertness and intelligence, and she had no recollection of her time spent in the hospital. The cyst was drained two more times over the next seven months and was eventually removed. After eight months of rehabilitation, Elsie no longer experienced headaches or akinetic mutism symptoms.^[1]

References

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Cairns, H; R. C. Oldfield; J.B. Pennybacker; D. Whitteridge (1941). "AKINETIC MUTISM WITH AN EPIDERMOID CYST OF THE 3RD VENTRICLE.". Brain 64 (4): 273–290. doi:10.1093/brain/64.4.273.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Otto, Anke; Inga Zerr; Maria Lantsch (1998). "Akinetic mutism as a classification criterion for the diagnosis of Creutzfeldt-Jakob Disease". Journal of Neurology, Neurosurgery, and Psychiatry 64: 524–528. doi:10.1136/jnnp.64.4.524. PMC 2170038. PMID 9576547.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k Nagaratnam, Nages; Kujan Nagaratnam; Kevin Ng; Patrick Diu (2004). "Akinetic mutism following stroke". Journal of Clinical Neuroscience 11 (1): 25–30. doi:10.1016/j.jocn.2003.04.002. PMID 14642361.
^ Sacks, Oliver (1973). Awakenings. United States: Vintage Books. p. 7.
^ ^a ^b ^c Nagaratnam, Nages; Catriona McNeil; J.S. Gilhotra (1999). "Akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction". Journal of the Neurological Sciences 163 (1): 70–73. doi:10.1016/s0022-510x(98)00329-3. PMID 10223414.
^ ^a ^b ^c ^d ^e ^f Yarns, Brandon; Davin Quinn (2013). "Telephone Effect in Akinetic Mutism From Traumatic Brain Injury". Psychosomatics 54 (6): 1–2. doi:10.1016/j.psym.2013.06.006. PMID 23932533.
^ Fix JD. Neuroanatomy. 4th ed.
^ Struss, DT; Alexander MP; Shallice T; Picton TW; Binns MA; Macdonald R; Borowiec A; Katz DI. (2005). "Multiple frontal systems controlling response speed". Neuropsychologia 43 (3): 396–417. doi:10.1016/j.neuropsychologia.2004.06.010. PMID 15707616.
^ Vachalová, Ivana; Viola Gindl; Josef G. Heckmann (August 2013). "Acute inferior homonymous quandrantanopia in a 71-year-old woman". Journal of Clinical Neuroscience 21: 683–685. doi:10.1016/j.jocn.2013.05.015. PMID 24210803.
^ Kotchoubey, Boris; Manfred Schneck; Simone Lang; Niels Birbaumer (2003). "Event-related brain potentials in a patient with akinetic mutism". Clinical Neurophysiology 33 (1): 23–30. doi:10.1016/S0987-7053(03)00003-0. PMID 12711129.
^ ^a ^b Rozen, Todd (2012). "Rapid resolution of akinetic mutism in delayed post-hypoxic leukoencephalopathy with intravenous magnesium sulfate". Neurorehabilitation 30 (4): 329–332. doi:10.3233/nre-2012-0763. PMID 22672948.
^ Yang, Chun-Pai; Huang, Shih, Lin, Lu, Kao, Hsieh, Huang, Lee, Tsai (2007). "Diminution of basal ganglia dopaminergic function may play an important role in the generation of akinetic mutism in a patient with anterior cerebral arterial infarct". Clinical Neurology and Neurosurgery 109 (7): 602–606. doi:10.1016/j.clineuro.2007.04.012. PMID 17543443.

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English Journal

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Gao T1, Lyu JH, Zhang JT, Lou X, Zhao W, Xing XW, Yang M, Yao Y, Tan QC, Tian CL, Huang XS, Ma L, Yu SY.
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PMID 25860342

Vascular Parkinsonism: Deconstructing a Syndrome.

Vizcarra JA1, Lang AE2, Sethi KD3, Espay AJ4.
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PMID 25693586

Japanese Journal

橈骨動脈を用いた健側浅側頭動脈本幹から患側前大脳動脈への"hemi-bonnet bypass"にて急性期血行再建を行った進行性脳梗塞の1例

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左総頚動脈閉塞の進行性脳梗塞症例に対して急性期血行再建術を施行した.左下肢麻痺で発症した86歳女性.24時間後のCT灌流撮影では両側前大脳動脈(ACA)領域および左中大脳動脈(MCA)領域の広範な血流低下を認めた.入院2日後に無動性無言を含む神経学的症状の悪化(NIHSS2→19)を認めたが,MRI diffusion画像では脳梗塞は左ACAおよびMCA分水嶺領域に軽微に認めるだけであった.Wil …
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NAID 40019325304

Related Pictures

★リンクテーブル★

リンク元	「日本昏睡尺度」「無動性無言症」「無動無言」
関連記事	「akinetic」

「日本昏睡尺度」

　　[★]

英: Japan Coma Scale, JCS
同: 3-3-9度方式、ジャパン・コーマ・スケール
関: 意識障害の評価法。グラスゴー・コーマ・スケール GCS

脳血管障害にはJCS
外傷にはGCS

JCS

1.覚醒している(confusion, senselessness, delirium)

1　だいたい意識清明だが、今ひとつはっきりしない
2　見当識障害あり
3　名前、生年月日がいえない

2.刺激すると覚醒する(stupor, lethargy, hypersomnia, somnolence, drowsiness)

10　呼びかけで容易に開眼する
20　大きな声、または体をゆさぶることにより開眼する
30　痛み刺激で辛うじて開眼する

3.刺激しても覚醒しない(deep coma, coma, semicoma)

100　はらいのける動作をする
200　手足を少し動かしたり顔をしかめたりする（除脳硬直を含む） →　除皮質硬直も200らしい(出典不明)
300　全く動かない

1.覚醒している(confusion, senselessness, delirium)
	1	だいたい意識清明だが、今ひとつはっきりしない
	2	見当識障害あり
	3	名前、生年月日がいえない
2.刺激すると覚醒する(stupor, lethargy, hypersomnia, somnolence, drowsiness)
	10	呼びかけで容易に開眼する　合目的的な運動(例えば、右手を握れ、離せ)をするし、言葉も出るが、間違いが多い
	20	大きな声、または体をゆさぶることにより開眼する　簡単な命令に応ずる(例えば、何らかの理由で開眼できない場合の離握手)
	30	痛み刺激で辛うじて開眼する　痛み刺激をくわえつつ呼びかけを繰り返すとかろうじて開眼する
3.刺激しても覚醒しない(deep coma, coma, semicoma)
	100	はらいのける動作をする
	200	手足を少し動かしたり顔をしかめたりする（除脳硬直を含む）
	300	全く動かない

付記する記号

以下に当てはまれば、xxx-RIAのように表記する

R: 不穏状態 restlessness
I: 尿失禁 incontinence
A: 無動性無言症 akinetic mutism/外套症 apallic state

JCS補足 IMD.41

10：合目的的な運動(例えば、右手を握れ、離せ)をするし、言葉も出るが、間違いが多い
20：簡単な命令に応ずる(例えば、何らかの理由で開眼できない場合の離握手)
30：痛み刺激をくわえつつ呼びかけを繰り返すとかろうじて開眼する

「無動性無言症」

　　[★]

英: akinetic mutism
同: 無動無言症。無動性無言、無動無言、無動性緘黙症
関: 遷延性植物状態

軽い意識混濁と意志発動障害

間脳から上部脳幹にかけての網様体や脳梁・帯状回の損傷によるもので、四肢の自発運動はみられず無言であるが、嚥下機能は保たれ、対象を注視したり、追視するなどの眼球運動もみられる。睡眠覚醒のリズムも保たれる。

Akinetic mutism refers to a partially or fully awake state in which the patient is able to form impressions and think but remains virtually immobile and mute. The condition results from damage in the regions of the medial thalamic nuclei or the frontal lobes (particularly lesions situated deeply or on the orbitofrontal surfaces), or from hydrocephalus. (HIM. chapter 268)

	失外套症候群	無動性無言症	閉じ込め症候群
障害部位	両側大脳半球の広範な障害	視床下部・脳幹	両側の橋底腹側部・延髄
障害の原因	変性疾患・無酸素症・一酸化炭素	梗塞・腫瘍	梗塞(脳底動脈血栓症)・損傷
脳波	低振幅徐波	高電位徐波	正常パターン
意識障害	有	有(軽度)	無
睡眠覚醒リズム	有(覚醒時開眼)	有	有
周囲の状況認知	不可	不可	可能
意思伝達	不可	不可	眼球運動や開閉眼で可
発話	不可	不可	不可

「無動無言」

　　[★] 無動性無言症　 akinetic mutism

「akinetic」

　　[★]

adj.

無動の

関: akinesia

[Cairns_1941-1] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Cairns, H; R. C. Oldfield; J.B. Pennybacker; D. Whitteridge (1941). "AKINETIC MUTISM WITH AN EPIDERMOID CYST OF THE 3RD VENTRICLE.". Brain 64 (4): 273–290. doi:10.1093/brain/64.4.273.

[Otto.2C_1998-2] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Otto, Anke; Inga Zerr; Maria Lantsch (1998). "Akinetic mutism as a classification criterion for the diagnosis of Creutzfeldt-Jakob Disease". Journal of Neurology, Neurosurgery, and Psychiatry 64: 524–528. doi:10.1136/jnnp.64.4.524. PMC 2170038. PMID 9576547.

[Nagaratnam.2C_mutism_following_stroke-3] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k Nagaratnam, Nages; Kujan Nagaratnam; Kevin Ng; Patrick Diu (2004). "Akinetic mutism following stroke". Journal of Clinical Neuroscience 11 (1): 25–30. doi:10.1016/j.jocn.2003.04.002. PMID 14642361.

[Awakenings-4] Sacks, Oliver (1973). Awakenings. United States: Vintage Books. p. 7.

[Nagaratnam.2C_aphasia_paper-5] Nagaratnam, Nages; Catriona McNeil; J.S. Gilhotra (1999). "Akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction". Journal of the Neurological Sciences 163 (1): 70–73. doi:10.1016/s0022-510x(98)00329-3. PMID 10223414.

[Yarns_2013-6] ^ ^a ^b ^c ^d ^e ^f Yarns, Brandon; Davin Quinn (2013). "Telephone Effect in Akinetic Mutism From Traumatic Brain Injury". Psychosomatics 54 (6): 1–2. doi:10.1016/j.psym.2013.06.006. PMID 23932533.

[7] Fix JD. Neuroanatomy. 4th ed.

[Struss-8] Struss, DT; Alexander MP; Shallice T; Picton TW; Binns MA; Macdonald R; Borowiec A; Katz DI. (2005). "Multiple frontal systems controlling response speed". Neuropsychologia 43 (3): 396–417. doi:10.1016/j.neuropsychologia.2004.06.010. PMID 15707616.

[Vachalova-9] Vachalová, Ivana; Viola Gindl; Josef G. Heckmann (August 2013). "Acute inferior homonymous quandrantanopia in a 71-year-old woman". Journal of Clinical Neuroscience 21: 683–685. doi:10.1016/j.jocn.2013.05.015. PMID 24210803.

[Kotchoubey.2C_2003-10] Kotchoubey, Boris; Manfred Schneck; Simone Lang; Niels Birbaumer (2003). "Event-related brain potentials in a patient with akinetic mutism". Clinical Neurophysiology 33 (1): 23–30. doi:10.1016/S0987-7053(03)00003-0. PMID 12711129.

[Rozen.2C_updated-11] Rozen, Todd (2012). "Rapid resolution of akinetic mutism in delayed post-hypoxic leukoencephalopathy with intravenous magnesium sulfate". Neurorehabilitation 30 (4): 329–332. doi:10.3233/nre-2012-0763. PMID 22672948.

[Yang_et_al.2C_2007-12] Yang, Chun-Pai; Huang, Shih, Lin, Lu, Kao, Hsieh, Huang, Lee, Tsai (2007). "Diminution of basal ganglia dopaminergic function may play an important role in the generation of akinetic mutism in a patient with anterior cerebral arterial infarct". Clinical Neurology and Neurosurgery 109 (7): 602–606. doi:10.1016/j.clineuro.2007.04.012. PMID 17543443.

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案内

akinetic mutism