Sitting Restlessness (Akathisia)

By | June 10, 2022

Akathisia, or sitting restlessness, is a symptom from the medical field of neurology. It does not occur by itself, but is mainly known to be a side effect of psychopharmaceutical drugs and should therefore always be taken into account.

What is seat rest?

Akathisia is a constant restlessness of the face, arms and legs under the influence of medication. There is often an inability to sit still or hold a posture. For what does heparin-induced thrombocytopenia mean, please visit

Inwardly, an urge for constant movement is felt. Drugs such as neuroleptics, antiemetics and dopamine agonists are known to be triggers, but they can also occur as an early symptom of Parkinson’s disease.


The causes of akathisia are to be found in the motor part of the central nervous system (CNS). This is made clear by the fact that it always occurs as a symptom or side effect when any drug or disease interferes with the dopaminergic system of the CNS – with neuroleptics this is sometimes desirable and at the same time part of a possibly excessive main effect, with dopaminergic antiemetics it is clear a side effect, since suppression of vomiting is also achieved via dopamine receptors.

Neuroleptics are psychotropic drugs that have a wide range of possible uses in neurology and psychiatry and are often used to treat psychoses, schizoaffective diseases, organic brain psychoses in older people, delusional hallucinations in alcohol withdrawal delirium, severe chronic pain and a large number of other small and large problems of the central nervous system.

Since they are prescribed so frequently, the side effects are also well known: the so-called extrapyramidal motor symptoms are the so-called ” early dyskinesias ” with cramps in the facial muscles and movement disorders of the neck and arms. These movements happen involuntarily and are caused by shifts in (among other things) the balance of dopamine transmitters in the brainstem. A parkinon-like syndrome (“parkinsonoid”) can also occur under these circumstances.

Akathisia belongs to this group of early side effects of neuroleptic therapy, which occur relatively frequently because their mechanism of origin is included in the drug’s mechanism of action. They are still relatively harmless and can usually be reversed when the drug is stopped. More feared are the so-called “tardive dyskinesias”, which can occur weeks to months after the first intake or even after discontinuation of neuroleptics and are often irreversible.

Antiemetics are drugs that are supposed to suppress nausea and vomiting “centrally” in the CNS. For this purpose, some antiemetics also use dopaminergic systems and receptors and are so unspecific that they also affect the motor systems and can trigger dyskinesia and akathisia.

Another possible cause of akathisia, if no medication has been taken, is Parkinson’s disease. Restlessness when sitting and moving can be a symptom, especially in the early stages.

Symptoms, Ailments & Signs

Sitting restlessness is primarily expressed by the characteristic inner restlessness. The affected person feels a strong urge to move and sometimes has the feeling of being electrified. Similar to restless legs syndrome, restlessness in the seat causes constant trembling of the arms and legs.

Although exercise relieves the symptoms for a short time, the symptoms then return relatively quickly. Tensions, pain and other muscle complaints occur as a result of a prolonged urge to move. Poor posture, joint diseases, inflammation and cramps cannot be ruled out either.

The constant movement can also lead to psychological stress, which in turn increases restlessness. Patients are very tense internally and externally and usually feel uncomfortable in their bodies. The symptoms can be permanent or limited to certain situations.

For example, in many patients restlessness occurs only a few days after taking certain medications, while in others it is limited to the morning hours or evening. The discomfort is usually temporary and goes away once the trigger is addressed. Long-term consequences or serious complications are not to be expected if restlessness in sitting is well treated.

Diagnosis & History

The symptom of akathisia is the subjectively tormenting, volitionally uncontrollable restlessness that is noticeable in the head and extremities. Akathisia (“inability to sit”) got its name from the fact that those affected have to constantly give in to their inner urge to move and are therefore unable to sit still in severe cases. However, such a movement only provides relief for a short time, so that the restlessness lasts permanently.

The transitions to other dys- or hyperkinesias (“too much movement”) are often fluid. In particular, there is a great similarity to restless legs syndrome, which mainly affects the legs – here, however, paresthesias in the legs in particular lead to a constant urge to move and there is usually no connection with neuroleptic therapy.

For the diagnosis of akathisia, the medication history is of great importance – if neuroleptics or dopaminergic antiemetics were taken in the weeks before, sitting and moving rest is a typical side effect. Otherwise, further research needs to be done, looking for other neurological symptoms and disorders. Apparative examinations are out of the question for the side effect akathisia, since the diagnosis can be made purely externally and based on the circumstances.


Sitting restlessness is always associated with inner tension. Those affected often feel uncomfortable in their bodies and have an increased risk of developing mental illness. However, the urge to move can also lead to physical complications. For example, poor posture or tendon and joint inflammation can occur if the same movement is performed over and over again.

Other symptoms can occur due to the triggering medication. In addition to sitting restlessness, neuroleptics are also associated with sleep disorders, concentration problems, loss of libido and other side effects and interactions. In the long term, such drugs can lead to serious liver, heart and kidney damage. Treating restlessness also carries risks.

The beta blockers administered can lead to a severe drop in blood pressure, dizziness, gastrointestinal problems, edema and impotence. If the patient suffers from circulatory disorders, severe asthma or low blood pressure, further complications can arise. Existing diabetes mellitus or renal insufficiency can lead to serious cardiovascular problems. If only the triggering medication is stopped to treat the sitting restlessness, this can also lead to problems. In addition to withdrawal symptoms, the original symptoms can recur.

When should you go to the doctor?

Restlessness should always be treated by a doctor. In most cases, this condition is a side effect of various medications, which is why it should be treated as soon as possible to prevent further complications. Self-healing cannot occur in the case of sitting restlessness if the medication is not discontinued or changed. However, a doctor should always be consulted before making any changes to medication.

A doctor should be consulted for sitting restlessness if the person concerned cannot sit still and his limbs usually move all the time. This leads to severe tension or even cramps in the muscles of the limbs, which can significantly reduce and limit the quality of life. Furthermore, stressed behavior also indicates restlessness and should be examined by a doctor if it occurs over a longer period of time.

In many cases, however, outsiders have to point out the restlessness to the person concerned and persuade him to seek treatment. Sitting restlessness can be recognized by a general practitioner. Further treatment usually depends on the exact cause and is carried out by a specialist. As a rule, sitting restlessness does not reduce the life expectancy of the person concerned.

Treatment & Therapy

In acute cases, akathisia can be treated with beta blockers, which are able to calm the body as a whole. Of course, if neuroleptic therapy can be avoided, discontinuation of the offending drugs is the most effective treatment, otherwise a reduction in dose may be considered. A combination with anticholinergic agents can also lead to success.


In the long term, neuroleptic therapy must be well planned and carefully monitored, since early dyskinesia is comparatively harmless, but movement disorders that occur later can sometimes not be reversed with longer therapy. The indication must therefore be made particularly strictly.


Since the bacteria that trigger Trichomycosis palmellina also occur naturally on the skin, aftercare after treatment of Trichomycosis palmellina consists of avoiding renewed incorrect or excessive colonization of the skin with these bacteria. For this purpose, the hair on formerly affected skin areas should be removed regularly.

In addition, a high level of skin hygiene should be maintained. This should primarily consist of daily showering with soap. Ideally, a skin-cleansing and disinfecting, artificially produced soap is used for this purpose. Regular hand and skin disinfection can also help to prevent the recurrence of trichomycosis palmellina, but is not absolutely necessary.

Nevertheless, regular disinfection of the hands is recommended once trichomycosis palmellina has been present, as this can prevent infection with other bacteria (staphylococcus aureus) that can cause skin diseases. Hands should therefore be thoroughly disinfected, especially after visiting public toilets.

In addition, regular check-ups at the dermatologist can help to detect a new infection of the skin at an early stage. If trichomycosis palmellina keeps coming back despite maintaining good personal hygiene, permanent hair removal using a laser may be necessary. This is especially true for people with excessive body hair. The benefits and risks of such a removal should be discussed in detail with the attending physician.

You can do that yourself

In addition to drug treatment with beta blockers, sitting restlessness is treated with various self-help measures. Akathisia patients may need physical therapy. You can support them with exercises at home. However, this only applies to mental restlessness.

If the symptoms are due to a physical illness such as Parkinson’s, it must be treated. Then the patients have to orientate themselves primarily to general measures. This includes rest and the avoidance of stress. In addition, any triggers should be identified and then avoided. An important action that every akathisia patient must take is to keep a complaint diary. Based on the symptoms written down in it, the neurologist can optimize the treatment.

Finally, if you feel restless in your seat, make sure you have a soft surface. Because patients move a lot and slide around on their buttocks, inflammation or poor posture can occur. An ergonomically designed chair is just as important as learning an optimal sitting position. Patients are best advised to consult an orthopedist or a sports medicine specialist.

In children who suffer from sitting restlessness, the suffering often returns on its own if the measures mentioned are observed. If the akathisia has already manifested itself severely, particular care should be taken to ensure that the prescribed medication is taken correctly.

Sitting Restlessness (Akathisia)