Akathisia - Find a specialist and information

Akathisia is a physical restlessness of movement in which the arms and legs have to be moved constantly. The constant physical urge to move also leads to inner restlessness. Akathisia often occurs as a symptom of Parkinson's disease, but is also frequently a side effect of certain medications.

Below you will find further information and selected akathisia specialists.

What does akathisia mean?

Akathisia means restlessness and is an early sign of Parkinson's disease. Akathisia also occurs in other diseases or is an undesirable side effect of certain medications.

The word comes from the Greek and means "not sitting". Since medications such as neuroleptics trigger akathisia, a consultation with an internist is necessary.

How does akathisia manifest itself?

Akathisia manifests itself through a noticeable physical restlessness that can become extremely severe. Those affected cannot sit, lie or stand still. Recurring movements of the facial muscles, hands and feet are characteristic. The movements follow certain patterns. Rocking, stomping, shuffling and swaying from one leg to the other are also typical of akathisia.

These symptoms are typical of akathisia:

• Physical restlessness
• Inner tension
• Difficulty concentrating
• Irritability
• Sleep disorders
• Lack of deep sleep
• Anxiety

Akathisia can also cause depression in patients who have no psychiatric history. Those affected suffer greatly due to the lack of sleep and the lack of control.

Causes & risk factors of akathisia

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

Akathisia also occurs in mental illnesses or cancer patients. Scientists have found that anti-nausea drugs commonly used in chemotherapy cause akathisia.

An imbalance in hormone levels (serotonin excess/dopamine deficiency) can be responsible for akathisia.

Dementia patients receiving antipsychotics often show symptoms of akathisia.

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

Patients with Parkinson's disease sometimes show pronounced akathisia @ ipopba /AdobeStock

Akathisia in Parkinson's disease

As Parkinson's therapy cannot do without neuroleptics, drug-induced restlessness of movement cannot be avoided. Typically, those affected cannot control their need to move.

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

With akathisia, there is usually no unpleasant feeling in the legs. Patients with akathisia can only satisfy the urge to move for a short time. They therefore have to move constantly: Weight shifting, alternating leg crossing and frequent walking around are typical.

Akathisia as a side effect of medication

Akathisia is often an undesirable side effect of neuroleptics. The increasing development of new drugs and the resulting movement disorders pose a major problem for doctors.

The strong urge to move develops in the first five to eight weeks after taking the medication. The level of the dose and how quickly the dose increases are key factors in whether akathisia breaks out. A doctor must therefore increase the dose carefully.

Serotonin uptake inhibitors can also cause akathisia.

Medications that do not directly interfere with dopamine metabolism can also cause movement disorders. Treatment consists of reducing or eliminating the medication.

Diagnosis of akathisia

Restlessness, anxiety and restlessness of movement are always a good reason to consult a doctor and have yourself examined.

The doctor can find the exact cause. In most cases, there is a concomitant illness or unfavorable medication.

However, the assessment of restlessness and movement disorders is not always easy and often leads to misjudgements. In everyday clinical practice, early diagnosis by observing behavior is desirable because it helps to avoid complications.

Patients who believe that 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 illnesses are present. Also important is the patient's mental state and what medication they are taking.
2. The doctor then carries out physical examinations. The doctor observes the following physical signs:

• General constitution
• Muscle strength
• reflexes
• Coordination of movements
• Gait pattern
• Unusual, repetitive movement patterns

1. The neurologist will further clarify the symptoms and make the final diagnosis. He is a specialist in movement disorders. The neurological examination and clarification of blood values are also part of the further examination.

Akathisia and restless legs syndrome

Restlessness in the legs is also typical of restless legs syndrome. The disease is similar to akathisia, but cannot be equated with it.

In restless legs syndrome (RLS), sufferers experience an unpleasant urge to move their legs, mainly in the calves. Accompanying sensations such as tingling or pulling are typical symptoms

Here you can find reasons for restless legs syndrome:

• Renal insufficiency
• Iron and folic acid deficiency
• Also vitamin B12 deficiency
• Pregnancy
• Rheumatoid arthritis
• Diabetes mellitus
• medication
• Alcohol and other stimulants

Therapy begins with a search for the underlying disease. Neurological tests are usually unremarkable.

In restless legs syndrome , sufferers have an unpleasant feeling in their legs, such as a twinge, cramps or pain @ Pepermpron /AdobeStock

Treatment of akathisia

The treatment of akathisia aims to alleviate symptoms and improve quality of life.

The respective cause of the movement disorders determines the therapy:

• If akathisia occurs as a side effect of a medication, the patient should discontinue it in consultation with the doctor. If the patient cannot do without the medication, a different dose or an alternative medication is advisable. If the akathisia is caused by a medication, it can disappear again if the doctor and patient act in good time.
• If akathisia occurs with Parkinson's, then medication with dopamine (L-dopa and anticholinergics)is the first choice. Physiotherapy and deep brain stimulation (DBS) also help with Parkinson's. The aim with Parkinson's is to delay the patient's need for care for as long as possible.
• Drug therapy with dopamine also helps patients with restless legs syndrome.
• The administration of beta-blockers or benzodiazepines can also help with akathisia. However, those affected should try them first. Not everyone can tolerate them.
• If iron deficiency is responsible for the restlessness, iron-containing medication can help. Their effect has been very well researched. Unfortunately, iron-containing medications have side effects such as sleep disorders and nausea. Sometimes the symptoms even get worse. This is why some doctors do not use this type of therapy, making it all the more important that patients who are taking medication have regular check-ups with their doctor.

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

• Balanced diet with sufficient vitamin C, iron and B vitamins,
• Avoidance of nicotine, alcohol and caffeine
• Physiotherapy, gymnastics and stretching exercises
• Fixed bedtimes