Akathisia or Restless Leg?

Years ago when I was first trying to figure out if there was any possible family history of movement disorders all I could come up with was that my father used to kick in his sleep and his mother didn’t like having to sit during long evening performances etc and I must have vaguely heard of restless leg because I mentioned that to a consultant. But it wasn’t until I saw the word Akathisia on a Dystonia patient forum and asked what it meant that I recognized what I was experiencing.

There is no information page on Parkinson’s UK about Akathisia. I searched and found only 1 link to a document where it is listed as a common symptom in PD: Allied Health Professionals’ competency framework for progressive neurological conditions. September 2018.

The following article outlines the serious consequences of misdiagnosing Akathisia:


Self-Harm in Sertraline-Induced Akathisia H. Nepal, E.Black, M.Bhattarai, Prim Care Companion CNS Disord 2016;18(6):

This morning I looked at the Missd twitter page and was amazed to see their organization has been putting adverts about Akathisia on the New York subway. As one commentator writes ( BOB FIDDAMAN@Fiddaman):

“Because the psychiatric profession won’t do it, the regulators won’t do it, suicide prevention orgs won’t do it, it has to be done by those who have suffered. Bravo @MISSDFoundation and all who sail in her. NYC Subway Ads Take Akathisia Out of the Darkness”


MISSD: “We ask that suicide prevention charities start including #akathisia info on their website & print materials to increase public awareness of adverse drug effects that precipitate iatrogenic #suicide.

… We appreciate all efforts to share accurate info to help others make well-informed healthcare decisions for themselves and loved ones.”

Here are some descriptions of what sounds like Restless Leg by people on this forum (Parkinson’s UK):

Boyo Jun '14 In addition to the general PD symptoms I suffer from symptoms similar to RLS ( cramping, creepy crawling, and throbbing of the lower legs).

Crawling sensation under my skin Tony43 Oct 3 I am taking Sinemet three times a day and half Sinemet at night. I am also on a 3mg Rotigotine patch. Recently I have occasionally had the strangest sensation under my skin on my legs and arms difficult to describe but it’s a crawling and shivering sensationit is unbearable I just have to keep moving.

Singing_Gardener Oct 4 I’m not sure it’s the same but I get strange sensations under the skin at the time when the sinemet is wearing off and before the next pill kicks in. I agree it’s very unpleasant. I’m also on 3 sinemet a day plus one rasagiline but don’t take anything at night.

maweejackie Oct 7 I had a crawling sensation all over, I call it wriggly! It’s just horrible what PD throws at us. I haven’t had it for a while. Maybe it’s the DBS I had in 2015, maybe it’s one of the many drugs I take. I’m on 5 Madopar, 14mg Ropinerole, Safinamide, Opicapone, all per day.


Restless legs syndrome , CHAUDHURI KR, APPIAH-KUBI LS , et al Journal of Neurology, Neurosurgery & Psychiatry 2001; 71: 143-146.

Misdiagnosis of RLS may occur due to nocturnal dyskinesias and akathisia in patients with Parkinson’s disease treated with levodopa…The differential diagnosis is broad and includes other conditions involving motor restlessness with sensory symptoms or disagreeable feelings in the legs. These include those with an inconsistent association with rest or sleep (… akathisia…and generalised restlessness similar to akathisia).

Restless Legs Syndrome and Leg Motor Restlessness in Parkinson’s Disease Keisuke Suzuki, Masayuki Miyamoto, Tomoyuki Miyamoto, and Koichi Hirata Parkinsons Dis. 2015; 2015: 490938.

Several conditions observed in PD, including sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon, should be differentiated from RLS.


Wondered about your EMAIL out on OCT 10th from the forum which quoted a couple of posts from me re Akathisia which apparently I described very well. Never heard that term before and neuro just talked a0out Anxiety. Wondering if I had that or not ?

rgds nOjalahey (Andy)

Hi, glad you found the post. This is the link for your original post.

INerves and Restlessness - extra dimension to Parkinsons! March 2013

I’ve posted a lot about Akathisia because the consequences of misdiagnosis can be catastrophic. Chapter below outlines criteria, clinical characteristics & need to identify any drugs you have taken which are known to cause it. You might wait a very long time for an expert to do this for you so DIY is called for.


Acute and Tardive Drug-induced Akathisia P.S.Sachdev (in Drug-Induced Movement Disorders K.D. Sethi 2004 Informa Health Care)

You can check separately for each drug online in the ‘Information for professionals’ section of side effects.

eg Madopar https://www.medicines.org.uk/emc/product/1111/pil March 2016

4.4 Special warnings and precautions for use

Depression can be part of the clinical picture in patients with Parkinson’s disease and RLS and may also occur in patients treated with Madopar. All patients should be carefully monitored for psychological changes and depression with or without suicidal ideation.

4.8 Undesirable effects

Psychiatric Disorders: Depression Anxiety Insomnia aggression

Nervous System Disorders: Dyskinesia (choreiform and athetotic)

Musculoskeletal and connective tissue disorders : Restless Legs Syndrome

As you can see the word akathisia appears nowhere. The emotional distress is often misdiagnosed as anxiety/depression (blame the patient not the drug) , the physical symptoms trivialized as restlessness.

Alternatively you can google the name of the drug together with the word akathisia and see if any patient/case reports come up. Or you can try the name of the drug with the term “Extrapyramidal symptoms” This covers any combination of the drug-induced movement disorders akathisia, tardive dystonia , tardive dyskinesia and parkinsonism

Drug-Induced Dyskinesia, Part 1: Treatment of Levodopa-Induced Dyskinesia. Vijayakumar D, Jankovic J. Drugs. 2016 May;76(7):759-77.

Dyskinesias encompass a variety of different hyperkinetic phenomenologies, particularly chorea, dystonia, stereotypies, and akathisia.

Levodopa-induced dyskinesia (LID) is one of the main types of drug-induced dyskinesia, occurring in patients with Parkinson’s disease (PD) who have been treated with levodopa for long time, but this side effect may be encountered even within a few weeks or months after initiation of levodopa therapy.

Akathisia in idiopathic Parkinson’s disease. Lang AE, Johnson K. Neurology. 1987 Mar;37(3):477-81.

Interviews of 100 patients with idiopathic Parkinson’s disease indicated that 68% periodically experienced the need to move and inability to remain still, usually because of well-defined causes such as parkinsonism and sensory complaints. Twenty-six patients could not explain the inability to remain still, a state of true akathisia.

Akathisia in Parkinson’s disease. Comella CL, Goetz CG. Mov Disord. 1994 Sep;9(5):545-9.

Overall, 45% of PD patients had akathisia as determined by clinical evaluation.

Nonmotor fluctuations in Parkinson’s disease: frequent and disabling. Witjas T, Kaphan E, Azulay JP, Blin O, Ceccaldi M, Pouget J, Poncet M, Chérif AA. Neurology. 2002 Aug 13;59(3):408-13.

All patients had had at least one type of NMF, most of which were associated with the “off” state.

Anxiety (66%), drenching sweats (64%), slowness of thinking (58%), fatigue (56%), and akathisia (54%) were the most frequent NMF.

Effect of levodopa and carbidopa on non-motor symptoms and signs of Parkinson’s disease. Rahman MM, Uddin MJ, Chowdhury JH, Chowdhury TI. Mymensingh Med J. 2014 Jan;23(1):18-23.

Among the non-motor symptoms (NMS), the most frequent symptoms at base line visit were fatigue 56.8%, excessive sweating 54.9%, insomnia 54.9%, akathisia 47.1%, anxiety 45.1%, constipation 17.6%.

https://outcometracker.org/library/BAS.pdf Barnes Akathisia Rating Scale (BARS) - tool for formal assessment