Introduction

The concept of akathisia had a long history in the shadows prior to and following the introduction of antipsychotics. It has become customary for authors approaching this topic to begin by explaining its origins, and the present author will maintain the tradition.

The term literally means ‘not sitting’ or an absence of the ability to sit (still). It was coined by Lad Haskovic in 1902 to describe the ‘compulsive’ standing and sitting of two male patients he thought – in tune with the times – to be suffering from ‘hysteria’. However, there were earlier descriptions of a similar, if not identical, phenomenon going back to Willis in the seventeenth century, and the American George Beard included a recognisable description as part of his ‘syndrome’ of neurasthenia (Sachdev, 1995a).

It was with the advent of epidemic encephalitis that the concept caught the wider attention of neurology, with a number of reports describing what Wilson referred to as a ‘paradoxical’ restlessness in association with post-encephalitic parkinsonism. Although the neurological basis of this symptomatology was established early, it would be some time before even neurologists could be clear about whether the features were of independent origins or merely secondary to core parkinsonian symptomatology such as the ‘stiffness’ of rigidity. This process was facilitated by the eponymous Dr Ekbom, who made his first appearance in 1944 with his accounts of the Restless Legs Syndrome, which was subsequently established as being a neurological condition that could occur in the absence of parkinsonism.