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

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).

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

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  1. 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

  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 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.

  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.

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