Histoire d’un symptôme : l’akathisie

Abstract

Akathisia, or a patient's mental and physical inability to stay still, results in an irrepressible need to move. This clinical symptom was described by a Czech physician, Ladislas Haškovec (1866–1944), in an article published by La Revue Neurologique in 1901. After a brief biography of this polyglot neurologist, we will give the current definitions of this condition. We will then compare the first two clinical cases with the observations published in the first half of the last century, to show how the originally favoured psychic cause, related to anxiety and phobias, evolved into an organic neurological cause, notably during the epidemic of encephalitis lethargica, described by von Economo. The introduction of antipsychotic treatment by neuroleptics greatly increased the number of cases, suggesting that this iatrogenic effect is the only cause of akathisia. The various clinical and pathophysiological interpretations of this collateral effect of an indispensable therapy show how theoretical speculations are refuted by direct observations of patients. There is reason to hope that the Barnes scale, designed to quantify and monitor the progression of akathisia, will improve treatment. We will conclude with a review of medical writings, starting in the 17th century, to better appreciate the clinical relation between akathisia and restless legs syndrome.