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akathisia

Etiology: 1) chronic neuroleptic administration 2) antiemetics - metoclopramide 3) dyskinetic movement disorder a) parkinsonism b) restless legs syndrome [4] Clinical manifestations: - a state of distressing inner restlessness coupled with repetitive movements - uncomfortable mental & physical restlessness - inability to sit still Diagnostic criteria: - may be diagnosed on the basis on clinical symptoms alone* * see Hillside Akathisia Scale [5] Management: 1) discontinue offending agent if possible 2) treated like drug-induced parkinsonism 3) substituting antipsychotic for one with more anticholinergic activity - trihexyphenidyl (Artane) - diphenhydramine 4) midazolam more effective but more sedating than diphenhydramine

Related

drug-induced parkinsonism restless legs syndrome; Willis-Ekbom disease (RLS)

General

sign/symptom movement disorder

References

  1. Harrison's Online, McGraw-Hill, 2002
  2. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
  3. Parlak I et al Midazolam vs diphenhydramine for the treatment of metoclopramide-induced akathisia: A randomized controlled trial. Acad Emerg Med 2007, 14:715 PMID: 17545174
  4. Medical Knowledge Self Assessment Program (MKSAP) 16, 17 American College of Physicians, Philadelphia 2012, 2015
  5. Hillside Akathisia Scale [HAS Version 4] http://img.medscape.com/pi/emed/ckb/neurology/1134815-1149724-1151826-1558757.pdf