Saturday, May 13, 2017

Akathisia vs Restless legs syndrome

Hey guys, Ikan posted a clinical vignette based on this differentiation. So I did a little digging.

Both Akathisia and RLS can be caused due to antipsychotics, Akathisia goes more with typical ones and RLS with atypical ones.

Besides RLS has some other characteristic features:

1. Associated with dysesthesia originating in legs whereas in case of akathisia patient feels like it's originating in the central core of the body.

2. RLS has evening-predominance, it disturbs sleep of the patient as the patient jerks his legs during sleep which might be noted by his gf or wife.

3. There is positive family history in RLS.

4. RLS can be induced by other centrally acting drugs like Diphenhydramine, Citalopram, Clonazepam etc if there is a positive family history.

Treatment:

First intervention should always be reduction of dose of antipsychotics.

While RLS responds well to dopamine agonists like Pramipexol and Ropinirole, Akathisia responds well to Mirtazapine, a tetracyclic antidepressant. Although withdrawing the causative drug works the best.
According to latest clinical trial reports, The first line treatment of akathisia is propranolol, second line is Benztropine​ and if these doesn't work we resort to benzodiazepines.

That's all! You never stop learning.

-VM

2 comments:

  1. Also, RLS is urge to move while resting and decreases with activity.

    Akathisia is a compelling need to be in constant motion.

    ReplyDelete
  2. How RLS occurs in chronic kidney disease.?

    ReplyDelete

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