Do you have a feeling to keep moving at all times? Or have your friends been telling you that you are abnormally in motion? A feeling of the compulsion to be in motion at all times or a feeling of inner restlessness exists in some people, though the percentage of persons who have this condition is low.

If you have noticed it yourself or some other persons have complained about what they are noticing concerning your restlessness, it is possible that you may be suffering from a medical condition known as Akathisia. The awareness of this problem should not make you further restless as there are potent treatments for it. You can be treated and all the symptoms go away to enable you resume your normal life again.

In this post, we shall take a look at what Akathisia is, its signs and symptoms, the causes, diagnosis, and treatment. So, if you have the challenge or know of someone who has it, relax and get some useful information from this post because they will definitely be of immense help to you.

What is Akathisia?

Akathisia is a disorder of movement which is distinguished by a feeling of impatience and a kind of pressure to continually move around. It is also characterized by actions like lifting the feet as if doing an on-the-spot marching, crossing the legs or and uncrossing them while in a sitting position, as well as swinging while sitting or standing.
Akathisia sufferers find it almost impossible to keep or sit still, and they are usually pacing, fidgeting, rocking from foot to foot, and constantly restless.

Symptoms of Akathisia

Some of the symptoms of akathisia include the following:

• Anxiety
• Painful discomfort especially in the knees
• Swaying or rocking from foot to foot
• A sense of inner discomfort or tension or a sense of needing to move
• Twisting
• Poor posture
• Muscle kinks
• Shifting repeatedly
• Twisting of the trunk or waist
• Repeatedly crossing and uncrossing the legs
• Lifting the feet as if marching
• Difficulty standing without pacing or walking
• Repeated bending of the neck or nodding of the head.

Causes

Akathisia is caused mainly by drugs, hence it is referred to as a drug-induced condition. However, it must be understood that the condition is not caused by just one type of drug. Below are a few known drugs that bring about akathisia.

Antipsychotics/Antidepressants

Akathisia has been found to result from a reduction in the level of dopamine signals in the brain. Besides, it is also caused by a rise in the level of serotonin signals. This makes akathisia to show up as a side effect of antidepressant or antipsychotic medications, or during the period of withdrawing from the use of the drugs.

Anti-migraine or anti-nausea medications

Some drugs used in the management of migraine or nausea also act like the aforementioned drugs and so, they are able to cause akathisia, though this is not common. The period between the use of the medication and the appearance of akathisia differ in people. While the condition shows up shortly after the commencement of the medication in some persons, it takes some months for it to manifest in others.

Selective serotonin reuptake inhibitors (SSRIs)

This is not purely a cause, but an existing akathisia is known to be exacerbated by SSRIs.

Drug withdrawal (barbiturates, cocaine, opioids or benzodiazepines)

Symptoms can manifest in a matter of weeks if the condition is a result of drug withdrawal. It is therefore, important to watch out for symptoms of akathisia weeks after withdrawing from opioids or any other stimulant drugs.

Other drugs

Research has shown that the above-listed groups of drugs are not the only ones that contribute to the development of akathisia. Some other drugs that have been implicated include Levodopa, methyldopa and dopamine antagonists, anticonvulsants, interferon alfa, lithium carbonate, sumatriptan, buspirone, pethidine, etc.

Diagnosis

Akathisia can be diagnosed using the Barnes Akathisia Scale. This scale is used for measuring the presence or severity of the condition. It assesses both subjective and objective criteria. It is difficult to accurately assess akathisia because a lot of disorders with similar symptoms are hard to differentiate. The main features that differentiate akathisia from other syndromes are primarily characteristics that are mostly subjective, such as a sense of impatience.

Treatment of Akathisia

Care must be taken when treating akathisia. Because it is usually induced by drug, treatment would require stopping the drug, reducing the dosage used for an existing treatment, or adopting a new drug. However, if you are currently on an antidepressant or an antipsychotic medication, it must have been prescribed for a reason. So, readjusting drug dosage may lead to untoward effects or even cause a further relapse in the psychiatric condition being treated with the drugs.

It would be wise to see your doctor if you notice that you have akathisia. The doctor knows exactly the type of medication to prescribe for you and how to handle the dosage in the course of managing the problem. However, here are some of the things the doctor is likely to recommend for you.

Dose adjustment

The symptoms can be controlled by adjustment in the dosage of the drugs. This must be purely managed by a professional doctor who would be sure that the reduction in dosage is achieving its intended purpose. However, if you are managing akathisia caused by benzodiazepine or opioids withdrawal, the reverse is usually the best – increasing the dosage temporarily and then gradually reducing it over certain periods may produce a significant improvement in the symptoms. Neuroleptic drugs should not be withdrawn abruptly lest they cause further problems.

Drug holidays

Sometimes, your doctor may advise you to go off the drug for a certain period to see if this can help alleviate the symptoms. You can even suggest to the doctor to allow you go on holidays while you watch the symptoms. But you should never stop the drugs on your own without consulting your doctor.

Change in prescription

It is possible for second-generation antipsychotic and antidepressants to still cause the condition. But they do this much more slowly than when the other drugs are employed. Find out from your doctor if it is possible to use alternative drugs.

Anticholinergics

Anticholinergics help in blocking some neurotransmitters. They are quite useful in some cases of akathisia, though they are primarily used in the management of respiratory, sleep-related or digestive conditions. Anticholinergics produce some funny side effects; it is better to try other medications before deciding to use them.

GABA Analogues

If the akathisia is caused by withdrawal from opioids and it is no longer possible to continue on the opioids, then GABA analogues like gabapentin and pregabalin which are generally used for the management of acute idiopathic akathisia may be used in some cases.

Other drugs

Neuroleptic-induced akathisia is also known to respond to certain drugs like β-adrenergic antagonists (e.g. Propranolol), serotonin antagonists (e.g. cyproheptadine), and Benzodiazepines (e.g. lorazepam). They can be helpful as alternative treatments for the condition.

Change of diet

Some of the symptoms of akathisia respond positively to Vitamin B6. Since the vitamin assists in reducing the symptoms, you should try and eat foods rich in Vitamin B6. Such foods include meat (such as beef and turkey) and carbohydrates like potatoes.

Is Akathisia permanent?

The answer to this question is a two-way thing. Akathisia can be both temporary and permanent conditions. If it is caused by medications, the withdrawal, reduction in dose or the switching of such drugs should normally bring an end to the condition. This depends on how well the drug issue is handled. Withdrawing some drugs like cocaine or opioids can worsen the condition.

However, it should be noted that some forms of akathisia can still continue for years even when you have stopped using the drugs that initially caused the problem. So, akathisia could go away when the cause is identified and removed early enough. But if it not handled on time, it can become a permanent condition.

How long does Akathisia last?

Akathisia can last for less than 6 months or it can also last for several years. When it lasts for less than 6 months, the condition is referred to as Acute Akathisia. But when it lasts for more than 6 months into several years, it is known as a Chronic Akathisia. Acute akathisia responds to treatment and goes away within six months. The chronic type is difficult to handle and it is generally slower in responding to treatment. In a nutshell, akathisia lasts from less than 6 months to several years, depending on the cause and how it is handled.

Conclusion

You should never take drugs that are not prescribed by your doctor. If you are on any medication and notice any strange development in your mood or movement, see the doctor immediately. It is always better to start handling Akathisia in the early stage because the prognosis is usually better when treatments are commenced on time.

Definition

Cephalhematoma can be defined as a medical condition, in which a hemorrhage occurs in newborn babies. The hemorrhage commonly takes place between the skull and the periosteum, being caused by the rupturing of blood vessels that are crossing the periosteum (membrane that covers the outer surface of the bones). The condition is associated with a subperiosteal inflammation, the further expansion being limited by the bones in the area (it cannot cross the suture lines).

This condition occurs in 1-2% of all the live births, being more often encountered in deliveries in which birth-assisting tools were used. This condition is not considered dangerous, with the exception of the situation in which neurological complications occur. However, it is important to understand that the condition on its own does not cause damage to the brain cells. The hemorrhage is located between the skull and the inner skin layers, so there is no connection to the brain. Male babies are more predisposed to developing cephalhematoma, in comparison to the female population. The hemorrhage can be unilateral or bilateral and it can resolve spontaneously, without any intervention being necessary. The bilateral involvement is encountered in 15% of all the cases.

Because the hemorrhage is a slow process, the condition is not obvious immediately after birth. In fact, it takes several hours after the birth, for the first symptoms to become apparent. If a skull fracture is associated with the cephalhematoma, it is possible that a bony protuberance is going to remain from the healing process. In the majority of the cases, the blood resulting from the hemorrhage is resorbed between the age of 2 weeks and 3 months.

What Causes Cephalohematoma?

These are the main causes that lead to the appearance of cephalhematoma:

• Prolonged or difficult second stage of labor (from the time of complete dilation to the actual delivery of the baby)
• Using certain instruments for the delivery (such as the ventouse or the forceps) – these instruments can cause trauma to the head, favoring the appearance of the cephalhematoma (small blood vessels in the periosteal region are broken, hence the hemorrhage)
• Vitamin C deficiency – considered more of a risk factor than actual cause
• Trauma to the birth
• Head of the infant larger than the pelvic area of the mother
• First pregnancy
• Labor process – the head bangs against the pelvic bone during the labor
• Large size of the baby (macrosomia) – the risk of cephalhematoma is higher in babies that are over the standard size
• More common in the births with vaginal delivery (even though it has been encountered in C-sections as well)

Symptoms of Cephalohematoma

In the situation that the condition is severe, the primary symptoms include the yellow tinge of the skin (jaundice), anemia and reduced blood pressure. Often times, the cephalhematoma is an indication that a fracture has occurred at the level of the skull. The appearance of this hemorrhage also increases the risk for infection, with potential complications such as osteomyelitis or meningitis. The swelling cannot progress due to the suture lines, being confined to the surface of the respective bone. The swelling has firm boundaries, being the largest on the 2nd or 3rd day from the actual hemorrhage.

The hemorrhage that occurs at the level of the brain will take several weeks to resorb, with the inflammation subsiding in a gradual manner. It is possible that the area of the hemorrhage remain calcified, having however a softer center (in the medical literature, this is also known as a depressed fracture). Upon palpation, the respective areas feels fluctuant (due to the accumulation of blood). Unnatural bulges on the baby’s head might also be noticed. The bulge is soft, if there is only a small amount of blood coming from the said hemorrhage. On the other hand, if the hemorrhage was more extensive, the bulge is going to be felt firm to the touch.

Anemia and hyperbilirubinemia are considered to be complications of the cephalhematoma. Infection is also considered a complication – however, this often occurs if an attempt is made to drain the blood from the respective care (breech in the medical care).

Pictures

Cephalohematoma Picture 1 : Showing the Scalp, Periosteum, Hemorrhage and Cranium

Cephalohematoma Picture 2 (Top of Baby’s head) : Cephalhematoma, Galea aponeurotica, Scalp, Subgaleal hemorrhage, Skull and periosteum, Dura mater, Arachnoid membrane, Sudural hematoma and Epidural Hemorrhage

Picture 3 (Coronal section of small child’s brain having Cephalohematoma between the Skull region and Periosteum) – Parts : Galeal aponeurosis, Periosteum (tough membrane covering bone), Blood, Sutural ligament, Scalp and Skull.

Diagnosis

The differential diagnosis can be made with the subgaleal hemorrhage. This is also known as the subaponeurotic hemorrhage, being a more extensive hemorrhage that occurs between the scalp and the bones of the skull (above the periosteum). There are more severe complications associated with this particular type of hemorrhage, including severe anemia and bruising.

Imaging studies, such as skull X-rays, CT scanning or MRI scans are recommended in patients who present neurological symptoms. The physical examination or observation can also be useful in making the diagnosis of cephalhematoma. No laboratory tests can be made in order to help with the diagnosis.

Treatment

There is no treatment for this condition. Usually, the patient is kept under observation. In patients who have developed jaundice (yellowing of the skin and the eye sclera), phototherapy is recommended. In the situation of severe anemia, blood transfusions are indicated. It is not recommended to aspirate or remove the blood that has accumulated due to the hemorrhage, due to the greater risk for infection (there is also the risk of abscess formation in the respective area). The blood will resorb on its own, taking even several months until it disappears completely.

As the hematoma resorbs, one will notice that the middle has disappeared firstly, with the outer rim becoming harder (due to the calcium). This is the normal evolution and one should not be worried about it. After a couple of months, X-rays or CT scans can be performed in order to see if the hemorrhage has resorbed completely and that there is no damage to the brain. Monitoring the baby is essential, especially if head trauma was associated with the cephalhematoma (risk of developmental delay).

Homeopathic treatment has also been proposed for the small patients diagnosed with cephalhematoma. Talk to the doctor before administering homeopathic treatment to your baby.