Akinesia

What is Akinesia?

Akinesia in literal meaning stands for loss or impairment of motor functions. Akinesia is characterized by a

• a lessening of spontaneity,
• paucity of gestures,
• diminished conversation,
• and apathy due to a problem with the nervous system.

It can be referred to as a neurological condition or a motor disorder in which there is an absence of normal motor functions or incapability to initiate a particular movement or motor function. The condition is often accompanied by stiffness in muscles around neck, leg and facial region.

Akinesia may be found in persons suffering from paralysis (temporary or permanent) or Parkinson’s disease or also from being in a coma. Akinesia may also be observed as an extrapyramidal behavioral side-effect of antipsychotic medication in various patients. Many a time the symptoms of Akinesia may be confused with that of depression, demoralization, or the “negative symptoms” of schizophrenia and thus, misdiagnosed or left untreated.

Akinesia Causes

Generally speaking, Akinesia occurs due to a problem in the nervous system, which concerns a particular trouble in picking and/or setting a particular motor program in motion. In Akinesia patients the basal ganglion of the brain gets affected, thus affecting the normal movement of the body. The patient, in general, becomes apathetic in nature and there is a decrease in unplanned movements. Either the movement is totally lost or there is a reduction of movement of the muscle.

General Causes Affecting the Normal Movement of Body:

1. Antipsychotic drug:  The most common cause of pure Akinesia is treatment with high potency first-generation antipsychotic drug. An antipsychotic drug lowers the dopamine levels in the body which is essential to treat schizophrenia. However lower levels of dopamine cause imbalance in the motor movement thus causing Akinesia.

2. Parkinson’s Disease: Similarly levels of dopamine are reduced in a patient suffering from Parkinson’s disease due to an impairment cause in the ganglion of nerve cells. The low levels of dopamine cause imbalance in neurotransmitters which in turn leads to disturbance in motor movements. The Acute cases of Akinesia have also been reported with infarction of caudate nucleus and the syndrome may also occur as a sequel to anoxic coma.

3. Heart Disease: Akinesia in rare cases may also be developed in the patients having heart disease history like atherosclerosis, stroke and other blood vessel conditions, causing severe life-threatening akinetic septum which deprives heart, of oxygen.

4. Fetal Akinesia deformation sequence (FADS): In certain cases congenital (right from birth) Akinesia may be caused due to chromosomal abnormalities which may lead to permanent non-functional motor movements since birth. In most cases, the child is stillborn in such condition or lives for a short duration after birth.

5. Accidental trauma: Akinesia may also be caused due to sudden accidental hit to the frontal lobe causing trauma and damage to nerve cells. Accidental or sudden trauma to frontal lobe may result in loss of movement as well as speech which is often referred to as Akinetic Mutism.

Apart from above-mentioned causes, Akinesia is often found to be associated with certain other diseases such as:

• Huntington’s disease – Akinesia is often seen in patients suffering from Huntington’s disease. In such cases, the patients experience a complete loss of movements or rigidness. Huntington’s disease occurs due to the impairment of nerve cells.
• Multiple pterygium syndromes – This is also a genetic mutation disorder which causes webbing of skin along with a loss of movements (Akinesia).
• Corticobasal degeneration – This is also a neurological disorder which affects the basal ganglia and cerebral cortex region of the brain affecting various body movements (Akinesia), rigidity in muscles and problem in swallowing food.

Akinesia Symptoms

A person with Akinesia usually appears disinterested or lifeless or the face may lose its normal expressions, this is mostly due to loss of energy or drive. A person suffering from Akinesia often complains of “feeling like a zombie” or feeling lethargic.

Effects of Akinesia:

Akinesia may affect either or both the motor and the cognitive spheres of the patient. When Akinesia affects the motor system it slows down the initiation and execution of general body actions like talking, walking or getting dressed up. While in the cognitive or Psychic Akinesia the thinking process becomes sluggish and the thoughts and reaction process in the patient becomes slow.

Clinical description of Akinesia, in general, includes motor movement symptoms like the slowing of movement, decrease in repetitive body movements like swinging of arm or walking. The patient often complains of difficulty in the initiation of movements which is often referred as Freezing or Festination. In general, the various symptoms of Akinesia can be summarized as below:

• Loss of motor movements and reflexes.
• Difficulty in the initiation of movements.
• Reduced blinking or movement of eyes.
• Difficulty in Speech.
• Loss of Facial expressions.
• Loss of interest in life or disinterest in the day to day activities.
• Difficulty in doing repetitive tasks.
• Getting tired or feeling lethargic all the time.
• Loss of Balance and Fear of falling
• Difficulty in getting in and out of bed.

Akinesia Treatment

The treatment therapy in general, used for Akinesia are usually similar to the Parkinson’s disorders as most of the time it has been found associated with a side effect in patients suffering from Parkinson’s disorder. However, the treatment can only begin once the doctor has found out the underlying cause and the specific disorder because of which symptoms of Akinesia are seen in the patient.

There are a number of pharmacologic therapies utilized to treat or alleviate Akinesia. Some of which are as follows:

1. Levodopa: This is the most common and most effective medicine to be used for treating Parkinsonism and its side effects such as Akinesia. Levodopa is used as a chemical building block which is converted into dopamine in patient’s body thus increasing the dopamine levels in the patient.
2. L-DOPS (L-threo-dihydroxyphenylserine; Droxidopa): This drug is a synthetic catecholamine acid which when taken orally gets converted into neurotransmitter Norepinephrine
3. Dopamine agonists: This class of drug helps in treating Akinesia by altering the dopamine levels in the body thus affecting the body movements. This drug acts by directly stimulating the dopamine receptors present in the brain. Few examples of dopamine agonists are Parlodel, Requip, and Neupro respectively.
4. Surgery: In rare cases, surgery is done which includes Thalamotomy, Pallidotomy, and electrical stimulation. In some cases, neural implants are done by adding the tissue that produces dopamine in the brain.
5. Physiotherapy: For some patients who have been bedridden for quite a long time, physiotherapy is also given to restore their muscular movements.

Most of the above drugs mentioned increase the levels of dopamine in the brain thus helping in restoring the lost body movements. Lastly, optimal care can be provided to the patient suffering from Akinesia after jointly discussing the medical management with the respective doctors and the family members of the patient.

Medical References:

https://www.merriam-webster.com/medical/akinesia

http://www.parkinsons.org/parkinsons-symptoms.html

http://jamanetwork.com/journals/jamapsychiatry/article-abstract/491365

(https://www.communitycarenc.org/media/files/antipsychotic-side-affect-checklist.pdf)

(Textbook of Clinical Neuropsychiatry and Behavioral Neuroscience, Third Edition pg 146)

Current Topics in Extrapyramidal Disorders Volume 16 of the series Journal of Neural  Transmission pp 129-136 Clinical Analysis of Akinesia H. Narabayashi