this article and any supplementary material should be cited as follows: wielenga-boiten je, ribbers...

This article and any supplementary material should be cited as follows: Wielenga-Boiten JE, Ribbers GM. Akathisia—rare cause of psychomotor agitation in patients with traumatic brain injury: Case report and review of literature. J Rehabil Res Dev. 2012;49(9):1349–54. http://dx.doi.org/10.1682/JRRD.2011.10.0202

Slideshow ProjectDOI:10.1682/JRRD.2011.10.0202JSP

Akathisia—rare 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



• 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.



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 didn’t 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.



Literature Review• 61 yr-old man.– Fall from ladder.– Motor restlessness.• Benzodiazepines only

mildly relieved symptoms.

• Subsequent prescription of bromocriptine completely resolved symptoms within days.

• 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.

• 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.



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.

this article and any supplementary material should be cited as follows: wielenga-boiten je, ribbers...

Documents