Akathisia refers to a state of continuous motor restlessness which, in most cases, is associated with a subjective and irresistible need to move. While sitting, akathisia produces characteristic continuous tapping movements of the feet, repetitive movements of the legs, and rocking movements of the trunk. In more severe cases, there is repetitive shifting of weight from 1 foot to the other and marching in place occurs while standing. Akathisia was first described in the early nineteenth century as a rare feature of a variety of conditions including encephalitis lethargica, postencephalitic parkinsonism, myoclonus, tic disorders, and acute psychosis. However, currently, in nearly all cases akathisia is due to drug effects.
KeywordsDeep Brain Stimulation Tardive Dyskinesia Involuntary Movement Repetitive Movement Acute Psychosis
Clip 1: patient is off APDs and displays continuous orofacial dyskinesia and choreoathetotic movements of her distal extremities. She has had recent left carpal tunnel surgery. Clip 2: patient is now on TBZ and is no longer displaying orofacial or lower limb dyskinesia. Instead, she shows signs of typical akathisia with continuous tapping movements of her legs while seated and standing. She describes a strong need to move which was not present prior to the use of TBZ. She has now had recent right carpal tunnel surgery (Video contribution from Dr. Ludy Shih, Beth Israel Deaconess Medical Center, Boston).
Drug-induced akathisia.mp4 (MP4 27,156KB)