Akinetic Mutism (Lack Of Voluntary Movement And / Or Speech)

[EnolaGaia]

First, a basic introduction to this odd condition ... Akinetic mutism is a syndrome or behavioral malaise in which voluntary muscular movement and speech are essentially extinguished. The patient is conscious, but cannot operate his / her body or voice. Specific symptoms and degree of severity can vary among patients. The condition is strongly associated with brain damage, including residual stroke damage in certain regions of the brain. The condition is often considered more a psychological / psychiatric problem than a physical one.

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

Akinetic mutism varies across all patients. Its form, intensity, and clinical features correspond more closely to its functional anatomy rather than to its pathology. ...

https://en.wikipedia.org/wiki/Akinetic_mutism

 

[EnolaGaia]

Here's a recent example ... This man had been unable to perform conscious movements or speech for 8 years. Dutch researchers administered a drug used in sleep aids, and the patient was able to move and talk again. More research is needed to determine whether a more persistent alleviation of symptoms can be obtained.

Awakening After a Sleeping Pill: Man With Serious Brain Injury Temporarily Recovered After 8 Years

A patient who could not move and talk spontaneously for eight years started to do so again after being administered a sleeping pill. The spectacular but temporary effect was visualized with brain scans, giving researchers from Radboud university medical center and Amsterdam UMC a better understanding of this disorder’s underlying neurophysiological processes. The article has been published in Cortex.

Eight years ago, Richard, at the time a man in his late 20s, was hospitalized after a serious lack of oxygen. He survived but suffered a severe brain injury. Richard was no longer able to talk, eat independently, or move spontaneously. He was admitted to a specialized nursing home. Willemijn van Erp, an elderly care physician and researcher at Radboud university medical center, was still in training when she met Richard. “It was clear that Richard saw and heard us,” she says, “but because of his brain injury, he was barely able to respond to us.” This rare condition is known as akinetic mutism. Akinetic means that the patient is no longer able to move consciously. Mutism refers to the absence of speech. ...

There is a small chance that patients with this condition will temporarily recover after administering the Zolpidem sleeping medication. Van Erp: “Because Richard’s situation seemed hopeless, the family and I decided to administer this medication to Richard. Against all expectations, Zolpidem had remarkable effects. After taking the sleep pill, Richard started talking, wanted to call his father, and started recognizing his brothers again. With some help, he could even get up from his wheelchair and walk short distances.” ...

Researchers at Amsterdam UMC, including neurosurgeon resident Hisse Arnts, have used brain scans to demonstrate the differences between the two situations. This provided them with information that could be important for Richard and other patients with severe non-congenital brain injuries. Arnts: “Richard’s brain scans show overactivity in certain parts of the brain. This overactivity causes noise and somehow shuts down the ‘good brain activity’. We have discovered that administering this sleeping medication can suppress this unwanted brain overactivity, creating space for speech and movement.” ...

FULL STORY: https://scitechdaily.com/awakening-...n-injury-temporarily-recovered-after-8-years/

 

[EnolaGaia]

Here are the bibliographic particulars and abstract of the published Dutch research cited above.

Hisse Arnts, Willemijn S. van Erp, Lennard I. Boon, Conrado A. Bosman, Marjolein M. Admiraal, Anouk Schrantee, Cyriel M.A. Pennartz, Rick Schuurman, Cornelis J. Stam, Anne-Fleur van Rootselaar, Arjan Hillebrand, Pepijn van den Munckhof
Awakening after a sleeping pill: Restoring functional brain networks after severe brain injury,
Cortex, Volume 132, 2020, Pages 135-146.
https://doi.org/10.1016/j.cortex.2020.08.011.

Abstract
Some patients with severe brain injury show short-term neurological improvements, such as recovery of consciousness, motor function, or speech after administering zolpidem, a GABA receptor agonist. The working mechanism of this paradoxical phenomenon remains unknown. In this study, we used electroencephalography and magnetoencephalography to investigate a spectacular zolpidem-induced awakening, including the recovery of functional communication and the ability to walk in a patient with severe hypoxic-ischemic brain injury. We show that cognitive deficits, speech loss, and motor impairments after severe brain injury are associated with stronger beta band connectivity throughout the brain and suggest that neurological recovery after zolpidem occurs with the restoration of beta band connectivity. This exploratory work proposes an essential role for beta rhythms in goal-directed behavior and cognition. It advocates further fundamental and clinical research on the role of increased beta band connectivity in the development of neurological deficits after severe brain injury.

SOURCE: http://www.sciencedirect.com/science/article/pii/S0010945220303130

 

[Ermintruder]

Many patients describe that as soon as they 'will' or attempt a movement, a 'counter-will' or 'resistance' rises up to meet them. ...

This intra-agonist state sounds conceptually to be very-disturbing, as does:

brain scans show overactivity in certain parts of the brain. This overactivity causes noise and somehow shuts down the ‘good brain activity'

This sound almost analogous to tinnitus, albeit at a deeper processing level.

I was aware of locked-in syndrome and certain forma of mutism, but this information has extended my broader understanding, thanks @EnolaGaia

It also serves to confirm my unwilling concession that there are too many things that are worse than death.