In the article, we will consider what it is - akinetic mutism. This is a consequence of severe and widespread trauma to brain structures. Psycho-traumatic factors do not affect the syndrome. This ailment is observed after a person leaves a coma of a pathological condition. Akinetic mutism is difficult, doctors often give poor predictions, since the processes in the brain are irreversible.
Causes
For the first time this illness was first discussed in medical practice in 1940. The psychiatrist Dr. Kearns specifically observed a sick patient with a brain tumor. Until this moment, pathology was considered only a mental deviation.
Akinetic mutism - most often this is a consequence of getting out of a coma. The cause of the coma could be various factors, one of them is a severe head injury.
Another cause of the disease in question is a benign or malignant tumor in the brain. Deviations most often occur if the pathological process proceeds very quickly.
Another cause of akinetic mutism is basilar artery thrombosis. Thanks to it, our brain is sufficiently supplied with oxygen and essential nutrients. People with osteochondrosis are at risk of getting such thrombosis. Sports and domestic injuries, injuries in a car accident that occurred in the cervical-collar zone or occipital can provoke the appearance of blood clots in this bloodstream.
Drug exposure
There are cases of akinetic mutism with emotional reactions from the toxic effects of drugs. This can happen due to an overdose of drugs or the interaction of various drugs with each other. Reception in large doses of some antibiotics provokes toxic poisoning. There have been cases of abnormalities after taking psychotropic drugs.
The cause of the development of such a disease can also be a gunshot wound if it touches the frontal lobes of the brain, the thalamus. Ischemic stroke, intracerebral and subarachnoid hemorrhage can also disrupt blood circulation.
In addition, akinetic mutism causes excessive accumulation of cerebrospinal fluid, an abscess of the brain in the head cavity.
In patients with HIV infection and alcohol poisoning
The disease is observed in patients with HIV infection, as it provokes various neuropsychiatric complications. Deviations are also found in alcohol poisoning associated with damage to nerve endings in the brain.
Emotional reactions in mutism
Akinetic mutism is a condition in which the patient completely loses speech, but the ability to speak is preserved. There is a lack of facial expressions and gestures, but the patient hears someone else's speech and understands it. He adequately perceives and reacts to events around him. He is well versed in space and time. Positive reactions are observed with loud noises, with temperature changes. There are no hallucinations and delusional states. Despite all the reactions, the patient is lying. He is not active, only able to shift his gaze from subject to subject, but for a short time.
One of the varieties of mutism is the psychogenic type of the disease, provoked by psychological trauma. There are times when this condition manifested itself in a selective form, when the patient talked only with selected people.
Symptoms of the disease
The stay of a person with akinetic mutism syndrome is very difficult. He is fully conscious, but not capable of normal communication. During examinations, a high tone of muscle tissue in the limbs is determined. When conducting additional examinations revealed the absence of violations in the musculoskeletal and speech apparatus.
Additionally, the patient is examined to exclude meningeal symptoms. The color of the skin of the patient is not changed. Blood pressure should be within normal limits, but there have been cases in which deviations were observed. The pulse at rest is rhythmic, within normal limits.
A characteristic symptom is complete silence. A person lacks both passive and active speech. The patient finds it difficult to speak his thoughts out loud, and there is also no ability to repeat phrases after the doctor. However, the patient understands what they say, the ability to analyze what he heard is preserved.
Another symptom is a complete lack of motor ability. A person is not able to control his body, while there is an opportunity to chew and swallow. There have been cases when patients consumed food that was fed from a spoon. But most often, the nutrition of such patients is carried out through a probe.
The patient is not observed during this period of a tense and restless state. Assess the emotional state of a person is not possible. After recovery, amnesia most often occurs, the patient does not remember anything about his condition.
Treatment for akinetic mutism
Doctors have a difficult task. Due to the severity of the condition, a thorough, long-term, comprehensive treatment is required under the daily supervision of medical personnel. The main goal of therapy is to diagnose the underlying disease that triggered akinetic mutism, and to take timely measures to eliminate the consequences of the pathology.
In most cases, surgery is necessary to save the patient's life. During the operation, the hematoma (accumulation of blood) is removed if the syndrome is provoked by a violation of the blood supply to the brain. In the event of a tumor, neoplasms are excised. If the cause is hydrocephalus, install drainage for the outflow of cerebrospinal fluid.
Based on the tests performed after the operation, they are treated with the following medicines: antipsychotic drugs - antipsychotics; nootropic drugs; SSRI class antidepressants; benzodiazepine tranquilizers; vitamin and mineral complexes; drugs that normalize blood pressure; anticoagulants - means that prevent the formation of blood clots.
The next step in the treatment are measures for the rehabilitation of speech functions. Doctors recommend constantly talking with the patient, hugging and holding his hand. A patient with akinetic mutism should be fed six times a day.
A mandatory requirement for patient care are regular hygiene procedures: washing your face, wiping off all skin, and caring for your mouth and hair. Special measures should be taken to prevent pressure sores. Relatives are recommended to provide a pleasant psychological situation to the patient. Perhaps resort to the help of a psychologist for further adaptation.
To restore motor activity, it is necessary to perform: breathing techniques; medical gymnastics; massage; acupuncture; physiotherapy.
Stages of recovery
Conventionally, doctors distinguish two stages of the recovery of akinetic mutism in neurology:
- Recovering understanding of speech. The patient lies with his eyes ajar, turns his head to sound or light. There is a constant and stable fixation of the gaze, tracking objects. The completion of this stage is the first manifestation of speech understanding. This can be evidenced by the fact that the patient hears the words addressed to him, his facial expressions change, requests expressed in words are fulfilled, for example, squeeze the hand of a doctor. But all the manipulations are gradual. At first, the doctor puts his hand in the patient’s palm, then tasks that provoke the patient’s greater motor activity become more complicated every day. They also try to work out more complex teams, with subsequent acceleration. Restoring understanding of speech speaks of the absence of brain damage.
- The return of one’s own speech with akinetic mutism after a coma. The patient makes more and more active and different movements. The pronunciation of words indicates the completion of the first stage. This cannot be spontaneous, more often in response to a doctor’s request to say something. The first sounds will be fuzzy. Only for some signs can you guess which sound was pronounced. Every day the situation improves, the patient begins to speak spontaneously, already without requests. After some time, pronunciation of phrases is already possible. Then it will be possible to conduct a dialogue with the patient, which will allow an objective assessment of his state of consciousness. Together with the restoration of speech function, the forms of voluntary movements expand. They become ordered.
Anartria
What is akinetic mutism with anarthria? One of the consequences of mutism is anarthria, i.e., severe speech impairment. It manifests itself in vague phrases, pronunciation in the nose, with an obvious stutter. The patient’s voice becomes hoarse. Often, after realizing such a defect, the patient communicates using notes or is generally silent. Often there is a problem with swallowing food.
Severity
The following degrees of anarthria are divided:
- mild degree - a person is able to pronounce sounds, syllables;
- moderate severity - only individual sounds can pronounce the patient;
- severe degree - the patient is completely unable to speak, his sound activity is zero.
Forecast
A disappointing prognosis for akinetic mutism can only be in the case when the organic damage to the brain is too large and can no longer be corrected. Also, if the patient had an advanced form of mental disorder, there could be no question of a full recovery.
Disease prevention
Doctors recommend to reduce the likelihood of pathology:
- to live an active lifestyle;
- do sport;
- in case of any somatic and mental deviations, consult a specialist in a timely manner.
The tendency to the appearance of mutism is least observed in mentally healthy people who control the level of pressure, the state of the heart and blood vessels, refuse alcohol and are not nervous.
We considered that this is akinetic mutism.