Post-stroke apathy is considered to be one of theclinical consequences of lesions affecting the struc-tures of the prefrontal cortex, basal ganglia, thalamusand limbic system. However, there is no current con-sensus on the treatment of post-stroke apathy, whichmainly depends on the underlying etiology and co-morbidities. A 62-year-old man, affected by hemor-rhagic stroke in the left thalamus, presented withmood depression, anhedonia, hyporexia and markedapathy. The patient underwent clinical evaluation be-fore and after receiving two different pharmacologi-cal therapies: escitalopram and bupropion. Only aftertreatment with the latter drug did the patient showchanges: high motivation and willingness to pursueactivities, greater interest in the external environmentand social life activities, and an overall reduction ofapathy. On the basis of our observations in this case,we hypothesize that the thalamic lesion resulted indisconnection of the fronto-striatal-thalamic circuits,and that loss of the dopaminergic striatal innervationcaused the patient’s apathetic state. The resolution ofthe apathetic disorder may be attributable to the ac-tion of the dopaminergic drug bupropion on themesocortical pathway.
Is bupropion useful in the treatment of post-strokethalamic apathy? A case report and considerations
De Luca R.;Casella C.
;Calabrò R. S.
2018-01-01
Abstract
Post-stroke apathy is considered to be one of theclinical consequences of lesions affecting the struc-tures of the prefrontal cortex, basal ganglia, thalamusand limbic system. However, there is no current con-sensus on the treatment of post-stroke apathy, whichmainly depends on the underlying etiology and co-morbidities. A 62-year-old man, affected by hemor-rhagic stroke in the left thalamus, presented withmood depression, anhedonia, hyporexia and markedapathy. The patient underwent clinical evaluation be-fore and after receiving two different pharmacologi-cal therapies: escitalopram and bupropion. Only aftertreatment with the latter drug did the patient showchanges: high motivation and willingness to pursueactivities, greater interest in the external environmentand social life activities, and an overall reduction ofapathy. On the basis of our observations in this case,we hypothesize that the thalamic lesion resulted indisconnection of the fronto-striatal-thalamic circuits,and that loss of the dopaminergic striatal innervationcaused the patient’s apathetic state. The resolution ofthe apathetic disorder may be attributable to the ac-tion of the dopaminergic drug bupropion on themesocortical pathway.Pubblicazioni consigliate
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