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Treatment of chronic akinetic mutism with atomoxetine: subtraction analysis of brain f-18 fluorodeoxyglucose positron emission tomographic images before and after medication: a case report

 Yong Wook Kim  ;  Ji-Cheol Shin  ;  Young-sil An 
 CLINICAL NEUROPHARMACOLOGY, Vol.33(4) : 209-211, 2010 
Journal Title
Issue Date
Akinetic Mutism/diagnostic imaging ; Akinetic Mutism/drug therapy* ; Akinetic Mutism/metabolism ; Aneurysm, Ruptured/complications ; Atomoxetine Hydrochloride ; Cognition/drug effects ; Fluorodeoxyglucose F18/metabolism ; Frontal Lobe/diagnostic imaging* ; Frontal Lobe/drug effects ; Frontal Lobe/metabolism ; Glucose/metabolism ; Humans ; Male ; Middle Aged ; Norepinephrine Plasma Membrane Transport Proteins/antagonists & inhibitors ; Occipital Lobe/diagnostic imaging* ; Occipital Lobe/drug effects ; Occipital Lobe/metabolism ; Positron-Emission Tomography ; Propylamines/therapeutic use* ; Subarachnoid Hemorrhage/etiology ; Subtraction Technique ; Time Factors
akinetic mutism ; atomoxetine
Akinetic mutism is a rare, complex neuropathologic disorder. The pharmaceutical treatment of akinetic mutism typically includes dopaminergic agents, but the resulting therapeutic effects are often unsatisfactory, and it remains unclear whether late treatment using these medications is effective. We present a case study of a 53-year-old male patient who developed akinetic mutism for a period of 7 months after a subarachnoid hemorrhage. The hemorrhage was caused by a ruptured aneurysm in the right anterior communicating artery, followed by a secondary infarction in the territory of the right anterior cerebral artery. Baseline brain F-18 fluorodeoxyglucose positron emission tomographic images revealed decreased glucose metabolism in both frontal lobes. Treatment with atomoxetine, a selective norepinephrine reuptake inhibitor, for a period of 8 weeks led to a clinically significant improvement in the patient's cognitive function and activities of daily living. A subtraction brain positron emission tomographic analysis after atomoxetine medication revealed increased cerebral glucose metabolism in both the premotor and visual association cortices. Thus, we suggest that atomoxetine can be a useful therapeutic option in the treatment of chronic akinetic mutism.
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1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Wook(김용욱) ORCID logo https://orcid.org/0000-0002-5234-2454
Shin, Ji Cheol(신지철) ORCID logo https://orcid.org/0000-0002-1133-1361
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