PM&R
Poster 454 Treatment of Akinetic Mutism With Atomoxetine. A Case Report. Yong Wook Kim, MD, PhD (Yonsei University College of Medicine, Seoul, Republic of Korea); Dong Soo Kim; Mi Hee Park, MD. Disclosures: Y. Kim, None. Patients or Programs: A 53-year-old man underwent surgery for a ruptured aneurysm in the right anterior communicating artery after SAH. The ruptured aneurysm was followed by a infarction in the right anterior cerebral artery. After surgery, the patient experienced a 7-month period of unresponsiveness. Program Description: On admission, he was alert but mute and exhibited only infrequent movements. Baseline brain F-18 FDG PET images demonstrated decreased cerebral metabolism in both frontal lobe. Initial score on the K-MMSE was 11 of 30, and FIM score was 31 of 126. We administered atomoxetine at an initial dosage of 10 mg/d, which was gradually increased to 70 mg/d over a 6-week period, then maintained at 70 mg/d for 2 weeks, and we performed follow-up PET evaluation. Subtraction PET imaging analysis between initial and follow-up was performed by a SISCOM program (SISCOM, Dayton, OH, USA). Then, the subtracted image was superimposed on a standard T1-
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weighted structural MRI, with 20% increases in brain metabolism considered significant. Coregistration of the subtracted PET image, and the patient’s CT image was performed by using Analyze 9.0 software (Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, USA). Setting: Severance rehabilitation hospital. Results: After 8 weeks of medication, patient’s K-MMSE and FIM scores had improved to 23 of 30 and 67 of 126, respectively. The results of subtraction PET image analysis revealed increased uptake of F-18 FDG in both frontal (premotor) and occipital (visual association) cortices after treatment. Discussion: In this case study, the administration of atomoxetine led to improved cognitive function, including improvements in attention and orientation and the patient’s functional abilities in daily activity without significant adverse effects. atomoxetine increased cerebral metabolism in the bilateral frontal (premotor) and occipital (visual association) cortices, both of which are known to be related to visuomotor processing. Conclusions: Our findings suggest that atomoxetine can be a useful therapeutic option in the management of akinetic mutism. However, additional controlled studies with larger samples to confirm the efficacy of atomoxetine in the treatment of chronic akinetic mutism are necessary.