Akathisia, or sitting restlessness, is a symptom from the medical field of neurology. It is less likely to occur on its own, but is most commonly known as a side effect of psychopharmaceutical medications and should always be considered.
What is sitting restlessness?
Akathisia is the term used to describe a constant motor restlessness of the face, arms, and legs when under the influence of medication. There is often an inability to sit still or remain in one posture. Internally, an urge to move constantly is felt. The main triggers are known to be medications such as neuroleptics, antiemetics, and dopamine agonists, but it can also occur as an early symptom of Parkinson’s disease.
Causes
The causes of akathisia are found in the motor part of the central nervous system (CNS). This is evident simply from the fact that it occurs as a symptom or side effect whenever any drug or disease interferes with the dopaminergic system of the CNS – in the case of neuroleptics, this is partly desired and at the same time part of a perhaps exaggerated main effect; in the case of dopaminergic antiemetics, it is clearly a side effect, since the suppression of vomiting is also achieved via dopamine receptors. Neuroleptics are psychotropic drugs that have multiple uses in neurology and psychiatry and are commonly used for psychosis, schizoaffective disorder, brain-organic psychosis in the elderly, delusional hallucinations in alcohol withdrawal delirium, severe chronic pain, and a variety of other minor and major central nervous system problems. Because they are so commonly prescribed, their side effects are also well known: The so-called extrapyramidal motor symptoms are the so-called “early dyskinesias” with spasms of the mimic muscles and movement disorders of the neck and arms. These movements occur involuntarily and result from shifts in (among other things) the dopamine transmitter balance of the brainstem. A Parkinon-like syndrome (“Parkinsonoid”) may also occur in these circumstances. Akathisia belongs to this group of early side effects of neuroleptic therapy, which occur relatively frequently because their mechanism of occurrence is virtually included in the drug’s mechanism of action. They are still relatively harmless and usually reversible when the drug is discontinued. More feared are the so-called “tardive dyskinesias”, which can occur weeks to months after initial use or even after discontinuation of neuroleptics and are often irreversible. Antiemetics are active substances that are supposed to suppress nausea and vomiting “centrally” in the CNS. To this end, some antiemetics also make use of dopaminergic systems and receptors, and are so nonspecific that they can also affect motor systems and cause dyskinesia and akathisia. Another possible cause of akathisia, if no medication has been taken, is Parkinson’s disease. Especially in early stages, sitting and movement restlessness may be a symptom.
Symptoms, complaints, and signs
Sit restlessness is primarily manifested by the characteristic inner restlessness. The affected person feels a strong urge to move and sometimes has the feeling of being under power. Similar to restless legs syndrome, restless sitting also causes constant trembling of the arms and legs. Exercise relieves the symptoms for a short time, but the symptoms return relatively quickly afterwards. As a result of a prolonged urge to move, tension, pain and other muscle complaints occur. Bad posture, joint disorders, inflammation and cramps cannot be ruled out either. The constant movement can also lead to psychological stress, which in turn increases sedentary behavior. Sufferers are very tense both internally and externally and usually feel uncomfortable in their bodies. The symptoms may persist permanently or be limited to certain situations. For example, in many patients, agitation occurs only a few days after taking certain medications, while in others it is limited to the morning hours or the evening. The symptoms are usually temporary and disappear as soon as the trigger is removed. Long-term consequences or serious complications are not to be expected with well-treated sitting restlessness.
Diagnosis and course
The symptom of akathisia is subjectively tormenting motor restlessness that cannot be influenced by will and is noticeable in the head and extremities. Akathisia (“inability to sit”) got its name precisely from the fact that affected persons must constantly give in to their inner urge to move and are therefore unable to sit still in severe cases. However, such movement always provides relief only briefly, so that the restlessness persists permanently. The transitions to other dys- or hyperkinesias (“too much movement”) are often fluid. In particular, there is also a great similarity to the restless legs syndrome, in which mainly the legs are affected – here, however, it is mainly insensations in the legs that lead to the constant urge to move and there is usually no connection with neuroleptic therapy. For the diagnosis of akathisia, the medication history is of great importance – if neuroleptics or dopaminergic antiemetics were taken in the weeks before, the sitting and movement rest is a typical side effect. Otherwise, further research is needed to look for other neurological symptoms and diseases. Apparative examinations are not an option for the side effect akathisia, as the diagnosis can be made purely externally and on the basis of the circumstances.
Complications
Sit restlessness is always associated with internal tension. Sufferers often feel uncomfortable in their bodies and have an increased risk of developing emotional distress. However, the urge to move can also lead to physical complications. For example, poor posture or tendon and joint inflammation can occur if the same movement is performed over and over again. Further discomfort can result from the medications that trigger the condition. For example, neuroleptics are associated with sleep disturbances, concentration problems, loss of libido, and other side effects and interactions in addition to sedentary behavior. In the long term, corresponding drugs can lead to serious liver, heart and kidney damage. Treatment of sedentary behavior also carries risks. For example, due to the beta-blockers administered, patients may experience a severe drop in blood pressure, dizziness, gastrointestinal distress, edema, and impotence. If the patient suffers from circulatory problems, severe asthma or low blood pressure, further complications may occur. If diabetes mellitus or renal insufficiency is present, serious cardiovascular problems may occur. If only the triggering medication is discontinued to treat sedentary behavior, this can also result in problems. In addition to withdrawal symptoms, the original symptoms may recur.
When should you see a doctor?
Sit restlessness should always be treated by a doctor. In most cases, this complaint represents a side effect of various medications, which is why it should also be treated as soon as only possible to prevent further complications. Self-cure cannot occur in case of sitting restlessness if medications are not discontinued or changed. However, a doctor should always be consulted first before any change in medication. A doctor should be consulted for sitting restlessness if the affected person cannot sit still and is usually always moving his or her limbs. This results in severe tension or even cramps in the muscles of the limbs, which can significantly reduce and limit the quality of life. Furthermore, stressed behavior also indicates sitting restlessness and should be examined by a doctor if it occurs over a long period of time. In many cases, however, outsiders must alert the sufferer to the sitting restlessness and persuade him or her to seek treatment. Sit restlessness can be recognized by a general practitioner. Further treatment usually depends on the exact cause and is carried out by a specialist. Usually, sitting restlessness does not reduce the life expectancy of the affected person.
Treatment and therapy
Therapy of akathisia in acute cases can be done with beta-blockers, which are able to calm the body as a whole. If neuroleptic therapy can be dispensed with, discontinuation of the precipitating medication is obviously the most effective treatment; otherwise, perhaps a reduction in dose can be considered. A combination with anticholinergic agents may also lead to success.
Prevention
In the long term, neuroleptic therapy must be well planned and carefully monitored because, although early dyskinesias are comparatively harmless, movement disorders that develop later are sometimes irreversible with prolonged therapy. Thus, the indication should be particularly strict.
Follow-up
Because the bacteria that cause trichomycosis palmellina also occur naturally on the skin, aftercare following treated trichomycosis palmellina consists of preventing recolonization or overgrowth of the skin with these bacteria. For this purpose, the hair on formerly affected skin areas should be removed regularly. In addition, a high level of skin hygiene should be maintained. This should primarily consist of daily showering with soap. Ideally, a skin-cleansing and disinfecting, artificially produced soap is used for this purpose. Regular hand and skin disinfection can also help to prevent the reoccurrence of trichomycosis palmellina, but is not mandatory for this purpose. Nevertheless, regular disinfection of the hands is recommended once trichomycosis palmellina has been present, as this can prevent infection with other bacteria (staphylococcus aureus) that can cause skin diseases. Hands should therefore be thoroughly disinfected, especially after visiting public toilets. In addition, regular check-ups with a dermatologist can help to detect a renewed infection of the skin at an early stage. If trichomycosis palmellina recurs repeatedly despite adherence to high levels of personal hygiene, permanent hair removal by laser may be necessary. This is especially true for individuals with excessive body hair. Benefits and risks of such removal should be discussed in detail with the attending physician.
What you can do yourself
In addition to drug treatment with beta-blockers, sitting agitation is treated by various self-help measures. Akathisia patients may need physical therapy. They can support this with exercises at home. However, this only applies to sitting restlessness caused by psychological factors. If the complaints are based on a physical disease such as Parkinson’s, this must be treated. In this case, patients must primarily follow general measures. These include taking it easy and avoiding stress. In addition, any triggers should be identified and subsequently avoided. An important measure that every akathisia patient must take is to create a complaints diary. Based on the symptoms written down in it, the neurologist can optimize the treatment. Lastly, care should be taken to provide a soft surface if the patient is sitting unsteadily. Because patients move around a lot and slide around on their buttocks, inflammation or postural damage can occur. An ergonomically shaped chair is just as important as learning an optimal sitting posture. Patients are best advised to consult an orthopedic surgeon or a sports medicine specialist. In children suffering from sitting akathisia, the condition often resolves itself if the aforementioned measures are followed. If akathisia has already manifested itself severely, special care should be taken to ensure that prescribed medications are taken correctly.
