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

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.

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

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