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Akinetic rnutism from hypothalamic damage

Successful treatment with dopamine agonists

Departments of Neurology (Drs. Ross and Stewart) and Psychiatry (Dr. Ross), the University of Texas Health Science Center at Dallas, TX.

Address correspondence and reprint requests to Dr. Ross, Department of Neurology, University of Texas Health Science Center at Dallas, 5323 Harry Hines Boulevard, Dallas TX 75235.

A patient with akinetic mutism after surgical removal of a tumor from the anterior hypothalamus responded to treatment with lergotrile and bromocriptine (dopamine receptor agonists) but not to carbidopdl-DOPA or methylphenidate (presynaptic dopamine mimetics). His pharmacologic response was consistent with animal models of hypothalamic-induced akinetic states and suggests that akinesia may be related to loss of dopaminergic input to anterior cingulate cortex or related structures rather than to the striatum.

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