Akathisia - Find a Specialist and Get Information

Akathisia refers to restlessness when sitting and is an early sign of Parkinson’s disease. Akathisia also occurs in other conditions or can be an unwanted side effect of certain medications.

The word comes from Greek and means “unable to sit.” Since medications such as neuroleptics can trigger akathisia, an evaluation by an internist is necessary.

Akathisia manifests as noticeable physical restlessness that can intensify significantly. Those affected cannot sit, lie down, or stand still. Recurring movements of the facial muscles, hands, and feet are characteristic. The movements follow specific patterns. Rocking, stamping, shuffling, and shifting from one leg to the other are also typical of akathisia.

These symptoms are typical of akathisia:

• Physical restlessness
• Internal tension
• Difficulty concentrating
• Irritability
• Sleep disturbances
• Lack of deep sleep
• Anxiety

Akathisia can also cause depression in patients with no history of psychiatric disorders. Those affected experience significant distress due to sleep deprivation and a lack of control over their condition.

Akathisia is a common symptom in patients with neuralgia and Parkinson’s disease.

Akathisia also occurs in patients with mental health conditions or cancer. Researchers have found that anti-nausea medications commonly used during chemotherapy can cause akathisia.

A hormonal imbalance (excess serotonin/dopamine deficiency) may be responsible for akathisia.

Dementia patients receiving antipsychotic medication often exhibit symptoms of akathisia.

In general, older people are more severely affected than younger people.

Patients with Parkinson’s disease sometimes exhibit pronounced akathisia @ ipopba /AdobeStock

Since Parkinson’s treatment cannot do without neuroleptics, medication-induced restlessness is unavoidable. A typical feature of this condition is that those affected cannot suppress their urge to move.

While there are similarities to restless legs syndrome, there are also clear differences:

With akathisia, there is generally no unpleasant sensation in the legs. Patients with akathisia can only briefly satisfy their urge to move. As a result, they must keep moving constantly: shifting their weight, alternately crossing their legs, and frequently pacing back and forth are typical behaviors.

Akathisia is often an unwanted side effect of neuroleptic medications. The increasing development of new drugs and the resulting movement disorders pose a major problem for physicians.

The strong urge to move typically arises within the first five to eight weeks after starting medication. The dose level and the rate at which the dose is increased are key factors in whether akathisia develops. Therefore, a doctor must increase the dose cautiously.

Serotonin reuptake inhibitors can also cause akathisia. 

Medications that do not directly affect dopamine metabolism can also cause movement disorders. Treatment involves reducing or discontinuing the medication.

Restlessness, anxiety, and motor agitation are always good reasons to see a doctor and get examined.

The doctor can determine the exact cause. In most cases, an underlying condition or an inappropriate medication is to blame.

However, assessing restlessness and movement disorders is not always straightforward and often leads to misdiagnosis. In everyday clinical practice, an early diagnosis based on behavioral observation is desirable, as it helps prevent complications.

Patients who believe they are suffering from akathisia should first consult a general practitioner (family doctor).

The diagnosis is made in several steps:

1. First, the doctor conducts a medical history interview with the patient. During this interview, the doctor determines whether any underlying conditions are present. The patient’s mental state and the medications they are taking are also important factors.
2. The doctor then performs a physical examination. During this examination, the doctor observes the following physical signs:

• General physical condition
• Muscle strength
• Reflexes
• Coordination of movements
• Gait
• Unusual, repetitive movement patterns

1. A neurologist will conduct further evaluation of the symptoms and make the final diagnosis. Neurologists are specialists in movement disorders. The neurological examination and blood tests are also part of the further evaluation.

Restlessness in the legs is also typical of Restless Legs Syndrome. The condition is similar to akathisia but is not the same thing.

In Restless Legs Syndrome (RLS), those affected experience an unpleasant urge to move their legs, primarily in the calves. Accompanying sensations such as tingling or a pulling sensation are typical symptoms

Here are some causes of Restless Legs Syndrome:

• Kidney failure 
• Iron and folic acid deficiency
• Vitamin B12 deficiency
• Pregnancy
• Rheumatoid arthritis
• Diabetes mellitus
• Medications
• Alcohol and other stimulants

Treatment begins with identifying the underlying condition. Neurological tests are usually normal.

In restless legs syndrome, those affected experience an unpleasant sensation in their legs, such as a prickling feeling, cramps, or pain @ Pepermpron /AdobeStock

Treatment for akathisia aims to relieve symptoms and improve quality of life.

The specific cause of the movement disorder determines the treatment:

• If akathisia occurs as a side effect of a medication, the patient should discontinue it in consultation with their doctor. If the patient cannot stop taking the medication, adjusting the dose or switching to an alternative medication is advisable. If akathisia is caused by a medication, it may resolve if the doctor and patient act promptly.
• If akathisia occurs in Parkinson’s disease, dopamine-based medications (L-Dopa and anticholinergics) are the first line of treatment. Physical therapy and deep brain stimulation (DBS) are also helpful for Parkinson’s disease. The goal in Parkinson’s disease is to delay the need for long-term care for as long as possible.
• Dopamine-based medication also helps patients with restless legs syndrome.
• Beta-blockers or benzodiazepines can also help with akathisia. However, those affected should try them first. Not everyone tolerates them.
• If iron deficiency is causing the restlessness, iron supplements can help. Their effectiveness has been well-documented. Unfortunately, iron supplements have side effects such as sleep disturbances and nausea. Sometimes the symptoms even worsen. For this reason, some doctors avoid this type of treatment. This makes it all the more important for patients to attend regular follow-up appointments with their doctor while taking medication.

Depending on the cause and severity of akathisia, there are various measures that can help alleviate the symptoms:

• A balanced diet with sufficient vitamin C, iron, and B vitamins,
• Avoiding nicotine, alcohol, and caffeine
• Physical therapy, exercise, and stretching
• Regular bedtimes