Akathisia

1
Akathisiarare cause of psychomotor agitation in
patients with traumatic brain injury Case report
and review of literature

• Janet E. Wielenga-Boiten, MD Gerard M. Ribbers,
  MD, PhD

2

• Aim
• Review case studies of akathisia in patients with
  traumatic brain injury (TBI).
• Discuss differential diagnosis, pathophysiology,
  treatment, and prognosis.
• Relevance
• Akathisia may cause postacute traumatic
  agitation, which may be misinterpreted as
  delirium and inappropriately treated with
  antipsychotics.

3
Case Study

• Nondisabled 34 yr-old woman with TBI and
  agitation at admission.
• Diagnosed with delirium and prescribed atypical
  antipsychotic and benzodiazepine.
• Agitated behavior worsened patient didnt sleep,
  exhausted.
• At reexamination, she described burning sensation
  from abdomen to legs, followed by irresistible
  urge to move.
• Diagnosis change to akathisia antipsychotic
  stopped and clonidine prescribed.
• Within 1 d urge to move disappeared.
• 5 mo postinjury
• Clonidine stopped without reemergence of symptoms.

4
Literature Review

• 22 yr-old woman.
• Car accident.
• Postinjury alcohol withdrawal.
• Given haloperidol, lorazepam, and SSRIs for
  agitation.
• Agitation and anxiety increased.
• SSRI stopped and tricyclic agent started.
• Symptoms resolved.

• 17 yr-old girl.
• Car accident.
• Increased agitation 3 wk after accident.
• Given amantadine and haloperidol.
• 6 wk later, patient still agitated, severely
  restless, and mute.
• Haloperidol stopped symptoms resolved
  spontaneously.

• 61 yr-old man.
• Fall from ladder.
• Motor restlessness.
• Benzodiazepines only mildly relieved symptoms.
• Subsequent prescription of bromocriptine
  completely resolved symptoms within days.

5
Conclusion

• Akathisia is rare cause of psychomotor agitation
  in patients with TBI.
• Its pathophysiology is poorly explained.
• No well-accepted treatment algorithm exists.
• Practitioners must consider akathisia when
  patient is agitated following TBI and
  stop/substitute potential offending medication.
• Avoid sedatives such as antipsychotics,
  benzodiazepines, and anticholinergics.
• Clonidine and bromocriptine may be first-choice
  medications for motor restlessness not explained
  by cognitive disorders.