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Neurorehabilitation and Neural Repair
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A Variant of Akinetic Mutism: Biochemical and Physiological Studies During Successful Withdrawal from Sinemet

Robert B. Wright

Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center

Jonathan L. Costa

Department of Physical Medicine and Rehabilitation, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, U.S.A.

Melanie Brandabur

Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center

Sylvain Junger

Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center

Amanda McRae

Department of Neuroscience Research Center of Goteborg, Institute of Neurobiology, Goteborg, Sweden

Paul M. Carvey

Department of Neurological Sciences, Rush-Presbyterian-St. Luke's Medical Center

A patient with a variant of akinetic mutism had responded to Sinemet and had been maintained at a functional level on this medication. We report follow-up studies of his speech and language skills, blink rate, and cerebrospinal fluid amine metabolites while on Sinemet and following its withdrawal. On Sinemet, cerebrospinal dopamine metabolites were normal at 90 min postdose. Off Sinemet, the patient experienced no clinical deterioration and some improvement in his speech and language skills. Although the cerebrospinal dopamine metabolites fell to markedly subnormal levels, his blink rate remained abnormally high (85-100/min) for 5 weeks. An antibody to dopaminergic neurons was present in the cerebrospinal fluid. The data suggest that the patient had sustained damage to the substantia nigra, with a resultant deficit in endogenous dopamine production. Remodeling appears to have occurred in the striatal system despite Sinemet-induced normal levels of dopamine available for release by striatal neurons. Key Words: Akinetic mutism—Parkinson's disease—Sinemet—Dopamine—Cerebrospinal fluid amine metabolites.

Neurorehabilitation and Neural Repair, Vol. 4, No. 3, 163-167 (1990)
DOI: 10.1177/136140969000400307
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