Akinesia in Parkinson’s disease: cause, symptoms, treatment

Akinesia is a well-known symptom of Parkinson’s disease. It is a pronounced lack of movement that can go as far as complete immobility. Those affected are no longer able to move their muscles and limbs voluntarily and automatically. They can only activate their arms and legs again after a certain period of time. Akinesia is always accompanied by a loss of spontaneity, which in turn can have a negative impact on the psyche. As the disease progresses, movements become increasingly difficult, less frequent and slower. However, the transition from a lack of movement (hypokinesia) and slow movements, as in the cardinal symptom of bradykinesia, to a blockage of movement (akinesia) is fluid.

We would like to inform you about an important symptom of Parkinson’s – akinesia. What exactly is behind it? What are the possible causes? How does akinesia manifest itself and how exactly does it differ from hypokinesia and bradykinesia? You will also find out how akinesia is diagnosed and what treatments are used.

Akinesia in Parkinson’s disease: what is it?

Akinesia is the medical term for immobility. Alongside the cardinal symptoms of bradykinesia (slowness of movement), tremor (trembling), rigor (muscle stiffness) and postural instability (postural instability), it is one of the most important motor movement disorders in Parkinson’s disease. Since the current guideline (2025), postural instability is no longer part of the cardinal symptoms.

In addition to akinesia, hypokinesia and bradykinesia also belong to the group of progressive slowing of movements and immobility in Parkinson’s disease. These terms are often lumped together in connection with Parkinson’s disease – despite subtle differences – and summarized under the term “bradykinesia” or “akinesia”.

Akinesia – immobility and immobility

Akinesia usually occurs without warning: Suddenly, as if out of the blue, there is a complete blockage of involuntary (unconscious), spontaneous movements and a high degree of immobility, immobility of the skeletal muscles. Those affected can then no longer move freely. Even movement routines such as putting on or taking off clothes, getting up from an armchair or simply speaking are temporarily no longer possible or take a long time. Consciously activating or ending movements is extremely difficult. The result can be so-called freezing – the freezing of movement – in Parkinson’s disease. The range of movement also becomes increasingly minimal over time, which can manifest itself in the form of a small-step gait pattern (triple steps) or smaller handwriting (micrography).

The term akinesia is often used as a synonym for a general lack of movement. However, this is not entirely correct, as hypokinesia would be the correct term in this case. Akinesia in Parkinson’s disease is ultimately the most severe form of hypokinesia.

Hypokinesia – lack of movement

Literally translated, hypokinesia means “moving less”. It refers to a reduced, restricted mobility, a lack of movement. In Parkinson’s, hypokinesia primarily refers to the musculoskeletal system. It describes a reduced frequency of movements, which therefore occur less frequently and are only slightly pronounced. The execution of a movement can also be delayed because it is more difficult to start, for example when walking or reaching for a cup.

Bradykinesia – slowing down of movement

Bradykinesia literally means “slow movements”. It refers to a slowing down of voluntary motor movements. Smiling, speaking, grasping, standing up or sitting down can only be performed slowly. Bradykinesia is often used as a collective term that also includes akinesia and hypokinesia. It is one of the cardinal symptoms of Parkinson’s disease.
Good to know: The path from bradykinesia and hypokinesia to akinesia, i.e. phases in which movements are completely blocked, is a gradual process in Parkinson’s disease. These symptoms of movement disorders can severely restrict those affected in everyday life.

Causes of akinesia in Parkinson’s disease

The cause of the severe lack of movement in Parkinson’s is the dopamine deficiency typical of the disease, which in turn is caused by the death of the dopaminergic cells in the black substance (substantia nigra) in the brain stem. The protein α-synuclein is responsible for the death of nerve cells in this area of our brain, where it clumps together and thus destroys the important functions of the nerve cells. This results in a dopamine deficiency, which causes movement disorders in Parkinson’s such as tremor, rigor, postural instability and akinesia.

The lack of the messenger substance (neurotransmitter) dopamine ultimately leads to a loss of control over the muscles and thus over the movements. Without dopamine, smooth interaction between muscle tension and relaxation is simply no longer possible. If the dopamine content drops by more than 50 percent, visible Parkinson’s symptoms such as akinesia appear.

Symptoms: How akinesia manifests itself in Parkinson’s patients

In akinesia, our voluntary movements in the arms and legs, trunk and facial muscles are impaired. At the beginning of the disease, only one side of the body is affected, later both sides. The muscular immobility and phases of blockages are reflected in posture, gait, facial expressions, speech and fine motor skills. This is how akinesia can manifest itself in Parkinson’s disease:

• Delay in movement: Arms and legs can only be brought into action after a more or less brief moment.
• Sudden onset of movement blockage: Akinesia can occur from one moment to the next and routine movements can no longer be performed.
• Gait disturbances: As the disease progresses, gait disorders also occur as part of akinesia. This is manifested, for example, by the affected person dragging one leg or taking small steps (triple steps). There is also often a so-called start inhibition. For example, if the traffic lights change from red to green, it is difficult to start walking or, conversely, there is a delay in stopping suddenly, which can sometimes be dangerous in everyday life. Even after sitting for a long time, standing up is very difficult and turning movements are only possible with intermediate steps.
• Balance disorders: In the advanced stages of Parkinson’s disease, symptoms such as balance disorders and dizziness also develop, which are associated with an increased risk of falls.
• Stooped posture: A stooped posture is also characteristic of Parkinson’s patients. This is caused by the large joints, such as the knee or shoulder joints, being held in a bent position. This means that the arms hang limply down the body and do not swing when walking or making other movements.
• Rigidity of facial expressions (hypomimia): Akinesia also manifests itself in the face, which becomes increasingly rigid. This phenomenon is also known as a “mask face”. The eyelids of the eyes close less, which can lead to dryness and eye disorders, or the corners of the mouth remain immobile. The facial expression appears impassive, which can be irritating for those around you.
• Speech disorders: Speech disorders also occur as part of akinesia. For example, as the disease progresses, those affected speak more and more quietly and monotonously or their speech becomes faster at the end of a sentence.
• Difficulty swallowing: Swallowing difficulties also cause increased problems for people with Parkinson’s over time. The consequences are increased salivation and an increase in saliva in the mouth, some of which can leak out of the mouth.
• Weakening of coordinated movements: Writing, getting dressed and undressed, tying shoes – completely normal everyday activities – can no longer be carried out properly or only very slowly. The good news is that there are many aids for everyday life that support mobility and dexterity.
• Changes in the typeface: Not only writing itself becomes a problem, the typeface also changes and becomes smaller, which is known as micrography.

Complication of akinesia: emergency akinetic crisis

It can occur as a serious complication in the final stage of Parkinson’s disease: the akinetic crisis. Suddenly, or within a few days, those affected can no longer move at all. Symptoms such as profuse sweating, increased blood pressure and an increasing heart rate occur. An akinetic crisis is an emergency that must be treated as quickly as possible – immediately – in a hospital.

The blockage also affects chewing and swallowing and makes eating and drinking impossible. This can result in an acute loss of fluids.

Akinesia in Parkinson’s disease: Diagnosis

Parkinson’s disease is diagnosed by a neurologist on the basis of a detailed medical history (symptoms, previous illnesses, medication taken, etc.) and neurological examinations (e.g. imaging procedures such as magnetic resonance imaging (MRI) or computer tomography (CT) of the brain).

The criteria for a Parkinson’s diagnosis include

• Bradykinesia and akinesia as well as another cardinal symptom: rigor, tremor (resting tremor) and postural instability
• Onset of symptoms on one side of the body
• Progressive and long-term course of the disease
• Clear response to the drug levodopa (L-dopa)
• Long-term response to drugs with a dopamine-like effect (dopamine agonists)

Parkinson’s disease is still not curable because the causes are not (yet) treatable. However, research into new Parkinson’s therapies is progressing. Until then, however, many drug and non-drug therapies can help and keep the movement disorders under control as best as possible.

Akinesia in Parkinson’s disease: treatment

What can you do specifically to treat akinesia? In addition to drug therapy, non-drug measures such as physiotherapy, occupational therapy, speech therapy and psychotherapy are also important pillars of treatment.

Drug treatment for akinesia

Various medications form the basis of treatment for increasing immobility. The active ingredients in the medication are intended to compensate for the lack of dopamine in the brain, which is responsible for akinesia. The medication alleviates many Parkinson’s symptoms, but does not eliminate the cause of the disease and cannot stop the progression of the disease.

The following medications can be used for akinesia:

• Levodopa (L-dopa): As a precursor of dopamine (is converted to dopamine in the brain), L-dopa is the most important medication for Parkinson’s and is used at all stages of the disease. Movement disorders and other symptoms can be significantly improved by taking it.
• Dopamine agonists: They are chemically very close to the messenger substance dopamine and are therefore able to imitate the effect of the neurotransmitter. They stimulate the dopamine receptors in the brain and can be used on their own or in combination with other medications. Like L-dopa, dopamine agonists can also be used at all stages of the disease, but are not as well tolerated in comparison.
• MAO inhibitors: MAO inhibitors (monoamine oxidase B inhibitors) delay or inhibit the breakdown of L-dopa and thus maintain the dopamine content in the brain for longer. The active ingredients rasagiline and selegiline can also increase the effect of levodopa and dopamine agonists. MAO inhibitors are mostly used in the early stages of Parkinson’s disease.
• COMT inhibitors: COMT inhibitors (catechol-O-methyltransferase inhibitors) work in a similar way to MAO inhibitors. In the blood, the enzyme COMT slows down the breakdown of L-dopa and thus ensures longer availability of L-dopa in the nervous system. COMT inhibitors must be taken in combination with levodopa, as otherwise they cannot develop their effect.

Pump therapy and infusion therapy for akinesia

In the later stages of Parkinson’s disease, when akinesia can no longer be adequately treated with tablets, fluctuations in effect in on or off phases or motor complications occur, so-called pump therapy is also available to those affected. Using a portable pump, the active substances (dopamine agonists) are continuously instilled through the skin (subcutaneously) via a catheter. Pump therapy improves the effect of the medication.

The drug L-dopa can also be administered in the form of infusion therapy. In this case, a portable pump is connected to a permanent probe through the abdominal skin into the small intestine. This allows the active ingredient to reach the intestine directly and ensures a balanced L-dopa level in the blood.

Deep brain stimulation (DBS) for akinesia

Deep brain stimulation can be used primarily to support the treatment of central Parkinson’s symptoms, i.e. akinesia, tremor and rigor, if, for example, there are severe fluctuations in effect during drug therapy or complications and the quality of life suffers significantly.

DBS is a surgical procedure in which electrodes are inserted into areas of the brain. An implanted stimulator, which is located under the collarbone and connected to the electrodes, emits weak electric shocks that cause electrical stimulation in the affected brain region and thus stimulate activity in the area. A major advantage of DBS is that the effect lasts for 24 hours and medication can be significantly reduced.

Non-medication treatment for Parkinson’s disease

Forms of therapy such as physiotherapy, speech therapy, occupational therapy and psychotherapy play an important role in the non-drug treatment of akinesia. They help those affected to improve their speech in the event of speech disorders, fine motor skills and balance, among other things, so that they can maintain their independence as best as possible. The following measures have a positive effect on movement disorders:

• Movement therapy: Sport and movement exercises can delay the progression of movement disorders somewhat. Particularly after diagnosis, i.e. at the beginning of the disease, it is important to promote physical activity and train movement sequences. Sports such as table tennis, dancing, stretching exercises, strength training or Qigong and Tai Chi also have a positive effect.
• Physiotherapy: Physiotherapy is an integral part of the treatment repertoire for akinesia. It is used to maintain and/or build up mobility and muscle strength. The unsteady gait associated with akinesia should also be improved with the help of physiotherapy in order to prevent falls and make life with Parkinson’s easier.
• Occupational therapy: Occupational therapy focuses on maintaining independence in everyday life. Occupational therapists help to train dexterity and fine motor skills with targeted exercises, including manual exercises such as painting or handicrafts. Everyday routines, such as putting on and taking off clothes or going to the toilet, are also practiced. Occupational therapy also provides information about home adaptations and aids and adapts them to the patient’s needs.
• Speech therapy: Speech disorders are among the problems that can be caused by akinesia. Speech therapists provide you with exercises to train the muscles in the face, tongue and larynx. Breathing techniques are also practiced, as well as articulation and swallowing sequences for swallowing disorders.
• Psychological support and self-help groups: Dealing with Parkinson’s disease can be psychologically very stressful. Psychotherapeutic support, whether in individual or group sessions, is often perceived as very relieving, as is the exchange with other Parkinson’s sufferers in self-help groups.