Is This Akathisia or Restless Legs?

Abstract

Restless legs syndrome (RLS) is common in psychiatric settings. It has a prevalence rate of 5–15% in the general population. It can be caused by various medications used to treat psychiatric symptoms such as antidepressants or antipsychotics. Patients with restless legs syndrome have an “urge to move the legs, usually accompanied by or in response to uncomfortable and unpleasant sensation in the legs.” The urge begins or worsens during periods of rest or inactivity, is partially or totally relieved by movement, and is worse in the evening or night compared to during the day or occurs only in the evening or night.

Akathisia on the other hand is a syndrome seen as a side effect of antipsychotic medications. It is characterized by subjective complaints of restlessness, often accompanied by observed excessive movements (such as leg movements, pacing, rocking from foot to foot, or inability to stand or sit still) developing within the first few weeks of starting or raising the dosage of a medication or after reducing the dosage of a medication used to treat extrapyramidal symptoms. This condition is thought to have originated from excessive dopamine blockade.

These two syndromes are often confused with each other. A few key features can help distinguish akathisia from RLS: (1) patients with akathisia do not have the paresthesias that RLS patients do; (2) in akathisia, the movements are not related to sleep; and (3) movement does not relieve the urge in Akathisia.

We describe a case scenario of akathisia induced by antipsychotic medication olanzapine and illustrate the differences between akathisia and RLS.