What is Akathesia?

Akathesia, properly spelled akathisia, is a type of movement disorder where patients experience extreme restlessness and have difficulty sitting or standing still. It is most commonly a side effect of medications, although it can also be associated with neurological problems. There are treatment options available to manage akathesia, and patients who experience it can discuss the situation with their doctors to get information about the available options.

In patients with akathesia, there can be an overwhelming need to move. The knees and spine may ache, and some patients experience pain. Pacing, jiggling the legs, twitching the arms, and moving around in other ways can relieve the sense of pressure and restlessness. This can be irritating for people around the patient, as being around someone who cannot sit still can be disruptive. Patients may also develop fatigue and pain from all the movement, forcing them to rest and causing distress to build up again.

A number of classes of drugs are associated with akathesia. These include some psychiatric medications, calcium channel blockers for heart conditions, stimulants, antidepressants, and some allergy medications. Restlessness can also be experienced as a symptom of drug withdrawal and it may become severe in these cases, especially when paired with other symptoms like emotional distress, pain, and nausea. The Barnes Akathisia Scale, designed to assess the degree of restlessness in a patient, can be used to determine how severe this condition is.

Neurological conditions like Parkinson's disease are also associated with akathesia. Studies have suggested that the movement disorder may not be caused by the disease, but rather by the medications used to treat it. It can sometimes be challenging to determine what is causing a movement disorder when patients are taking medications known to cause such disorders. Leaving patients without treatment to see if their neurological problems are the underlying cause is not considered ethical, making it hard to learn more.

The most common treatment for akathesia is adjustment of the patient's medications. Changing the dosage and timing may cause a reduction in side effects and the dosage can be slowly shifted until the point where the patient receives benefits with minimal side effects is reached. Other drugs can also be prescribed to treat the restlessness, although this can create the risk of polypharmacy, where patients are taking large numbers of medications to treat a condition and manage the side effects associated with the original medications, potentially resulting in adverse drug interactions or difficulty adhering to a drug regimen.