title: Preserved auditory cognitive ERPs in severe akinetic mutism: a case report.
abstract: kinetic mustism is a dramatic deficit in spontaneous initiation of voluntary motor and speech acts, usually secondary to bilateral lesions of the anterior cingulate cortices and supplementary motor areas [Principles of Neurology, McGraw-Hill, New York, 1989]. Given the obvious limitations of traditional neuropsychological testing in this clinical context, the use of neurophysiological tools such as bedside auditory cognitive event-related potentials (ERPs), recently proven to be relevant to evaluate comatose and vegetative patients [Clin. Neurophysiol. 110 (9) (1999) 1601; News Physiol. Sci. 17 (2002) 38], may constitute an interesting alternative. Here, we present the ERPs of a 38-year-old right-handed woman with severe akinetic mutism recorded in a passive auditory odd-ball paradigm. In spite of this severe clinical state, we could observe the presence of a "Mismatch Negativity", and of a larger P300 in rare trials than in frequent ones. By revealing a high level of cognitive integration of environmental auditory information, our study emphasizes the potential clinical relevance of MMN and P300 recordings in akinetic mutism to assess patient cognitive functioning.
authors.affiliation: Fédération de Neurophysiologie Clinique, Hôpital de la Pitié-Salpêtrière 47-83 Bd de l'Hôpital, 75013 Paris, France. lionel.naccache@wanadoo.fr
authors.forename: Lionel
authors.initials: L
authors.lastname: Naccache
authors.forename: Michaël
authors.initials: M
authors.lastname: Obadia
authors.forename: Sophie
authors.initials: S
authors.lastname: Crozier
authors.forename: Olivier
authors.initials: O
authors.lastname: Detante
authors.forename: Corinne
authors.initials: C
authors.lastname: Guillerm
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonneville
authors.forename: Didier
authors.initials: D
authors.lastname: Dormont
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Willer
authors.forename: Yves
authors.initials: Y
authors.lastname: Samson
mesh_terms: D000328:Adult; D000405:Akinetic Mutism / Q000175:diagnosis / Q000503:physiopathology*; D001307:Auditory Perception / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology*; D004569:Electroencephalography; D018913:Event-Related Potentials, P300; D005072:Evoked Potentials, Auditory; D005260:Female; D006801:Humans; D012720:Severity of Illness Index