UMEM Educational Pearls

Category: Neurology

Title: Akathisia - Clinical Tool for Assessment & Treatment Options

Keywords: akathisia, diphenhydramine, restlessness, neuroleptics, anti-emetics (PubMed Search)

Posted: 5/6/2009 by Aisha Liferidge, MD (Updated: 4/18/2024)
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Akathisia is an adverse effect sometimes associated with the administration of medications such as neuroleptic anti-psychotics (i.e. chlorpromazine (Thorazine); haloperidol (Haldol); ziprazidone (Geodon)) and dopamine-blocking anti-emetics (i.e. metoclopramide (Reglan); prochlorperazine (Compazine)).

This unpleasant symptom complex consists of restlessness and agitation, the severity of which correlates with the dose of the causative agent.

Treatment classically consists of stopping or decreasing the dose of the causative agent and administering diphenhydramine (Benadryl).

Benzodiazepines, beta blockers, and the antihistamine cyproheptadine have also been used with success.

The following instrument, a modified version of the Prince Henry Hospital Scale of Akathisia, can be used to clinically assess for akathisia in a standardized fashion:

Subjective Findings

Do you feel restless or the urge to move especially in th legs?

0=No (none) 1=Some times (mild) 2=Most times (mod) 3=All times (severe)

Objective Findings

Observe patient for 2 full minutes on stopwatch:

For how much time were they off their stretcher?

0=None 1=1 to 30 sec. 2=31 to 60 secs. 3=61 to 108 secs. 4=Whole time

For how much time do they have purposeless or semi-purposeless leg or foot movement?

0=None 1=1 to 30 sec. 2=31 to 60 secs. 3=61 to 108 secs. 4=Whole time

Diagnosis requires an elevation of 1 grade or more in the reported severity of subjective findings between the baseline and follow-up assessment (i.e. from none to mild, mild to mod.), with objective corroboration.

References

Friedman, et al. "A Randomized Trial of Diphenhydramine as Prophylaxis Against Metoclopramide-Induced Akathisia in Nauseated Emergency Department Patients." Annals of Emergency Medicine, 53(3): March 2009.