Supplementary Material for: Case Report: Treatment of akinetic mutism after unilateral anterior cerebral artery infarction with methylphenidate and levodopa/benserazide

Introduction: Akinetic mutism is a severe state of impaired volition that can result from a stroke. Its therapeutic evidence relies on single case reports that used atomoxetine or levodopa with variable latency and efficacy.
Case presentation: We present the case of a 54-year-old woman who developed akinetic mutism after infarction in the territory of the right anterior cerebral artery, successfully treated with methylphenidate and levodopa/benserazide. Clinical examination showed a patient lacking any spontaneous speech and movement while opening her eyes and fixating. Suspecting akinetic mutism after a comprehensive diagnostic work-up, we started an individual therapy attempt with methylphenidate 10 mg and levodopa/benserazide 100/25 mg twice daily. Both drugs affect the dopaminergic and noradrenergic transmission in the frontal-subcortical circuit, compromised in akinetic mutism. We saw rapid and sustained improvement in her volitional actions, devoid of side effects. Finally, the patient was actively communicating and moving her limbs.
Conclusion: We discuss the patient's favorable clinical course in response to the synergistic combination of methylphenidate and levodopa/benserazide, emerging as a promising treatment strategy, and provide a brief literature review of treatment options in akinetic mutism following stroke.

引言：无动性缄默症（Akinetic mutism）是一种可由脑卒中引发的严重意志损害状态。目前其治疗相关证据仅依托于使用阿托西汀或左旋多巴的单病例报告，且这类治疗的起效时长与疗效均存在差异。

病例报告：本文报告1例54岁女性患者，因右侧大脑前动脉供血区脑梗死继发无动性缄默症，经哌甲酯与左旋多巴/苄丝肼联合治疗后成功康复。临床检查可见患者睁眼且凝视时无任何自发言语与自主运动。经全面诊断评估后确诊为无动性缄默症，我们遂启动个体化治疗尝试：予哌甲酯10mg、左旋多巴/苄丝肼100/25mg，每日两次给药。两种药物均可作用于无动性缄默症受损的额-皮层下环路的多巴胺能与去甲肾上腺素能传导通路。我们观察到患者的自主行为得到快速且持续的改善，且未出现不良反应。最终患者可主动交流并自主活动四肢。

结论：本文探讨了该患者对哌甲酯与左旋多巴/苄丝肼联合用药的协同作用产生的良好临床转归，该方案有望成为脑卒中后无动性缄默症的潜在治疗策略，并对脑卒中后无动性缄默症的治疗方案进行简要文献回顾。