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![Page 1: This article and any supplementary material should be cited as follows: Wielenga-Boiten JE, Ribbers GM. Akathisia—rare cause of psychomotor agitation in.](https://reader036.fdocuments.net/reader036/viewer/2022083006/56649f395503460f94c55fbb/html5/thumbnails/1.jpg)
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
![Page 2: This article and any supplementary material should be cited as follows: Wielenga-Boiten JE, Ribbers GM. Akathisia—rare cause of psychomotor agitation in.](https://reader036.fdocuments.net/reader036/viewer/2022083006/56649f395503460f94c55fbb/html5/thumbnails/2.jpg)
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
• 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.
![Page 3: This article and any supplementary material should be cited as follows: Wielenga-Boiten JE, Ribbers GM. Akathisia—rare cause of psychomotor agitation in.](https://reader036.fdocuments.net/reader036/viewer/2022083006/56649f395503460f94c55fbb/html5/thumbnails/3.jpg)
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
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.
![Page 4: This article and any supplementary material should be cited as follows: Wielenga-Boiten JE, Ribbers GM. Akathisia—rare cause of psychomotor agitation in.](https://reader036.fdocuments.net/reader036/viewer/2022083006/56649f395503460f94c55fbb/html5/thumbnails/4.jpg)
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
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.
![Page 5: This article and any supplementary material should be cited as follows: Wielenga-Boiten JE, Ribbers GM. Akathisia—rare cause of psychomotor agitation in.](https://reader036.fdocuments.net/reader036/viewer/2022083006/56649f395503460f94c55fbb/html5/thumbnails/5.jpg)
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
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.