A 25-year-old woman with multiple sclerosis and an affective disorder
probably secondary to MS presented with multiple neurological signs and
symptoms suggestive of active MS, most prominently akinetic mutism. Spinal
fluid analysis and MRI supported a diagnosis of active MS. SPECT and EEG
were nonspecifically abnormal. After 6 weeks of severe akinetic mutism
refractory to one ECT treatment and trials of steroids and stimulants, the
patient recovered spontaneously over a 2-month period. An acute brainstem
lesion seen on MRI may explain this patient's akinetic mutism.