1. 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 Project DOI: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

2. 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 Project DOI:10.1682/JRRD.2011.10.0202JSP 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. 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 Project DOI:10.1682/JRRD.2011.10.0202JSP 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. 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 Project DOI:10.1682/JRRD.2011.10.0202JSP 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.

5. 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 Project DOI:10.1682/JRRD.2011.10.0202JSP 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.