Objective: To report the co-existence of Restless Genital Syndrome (RGS) and Dementia with Lewy Body (DLB), and to highlight the responsiveness to rotigotine (dopamine agonist) patches.

Background: RGS is described as a sense of genital discomfort in variable ways, including pain, tingling, burning, or itchy sensations that involve the perineal area and/or the external genitalia of either sexes. It had been previously reported with Parkinson’s disease, atypical or secondary parkinsonism, or even normal individuals[1]. However, this could be the first time to be reported with DLB.

Method: An 80-year-old man with diagnosis of DLB since 2013. He presented with REM sleep behavior disorder, visual hallucinations, fluctuating level of attention, progressive memory impairment and visual-spatial abnormality. He -later on- presented with parkinsonian manifestations (tremors, gait instability, bradykinesia). MRI brain showed generalized cortical atrophy, while FDG-PET scan showed reduced metabolic activity over both parietal lobes, predominantly on the left side. He was on sinemet, mirtazapine and quitiapine. Recently he presented with attacks of abnormal sensation in his genital and perineal area, described as unpleasant, itching and burning in nature. It occurred anytime during the day, but more at night. In addition, it was progressively increasing in frequency and pushed the patient to itch, sometimes inappropriately in public. This sensation became worse on sitting or lying, while improved during walking or physical activity. It also resulted in superficial genital bleeding, sleep disturbance, sever irritability and impacted upon his quality of life negatively. Surgical, urological and dermatological consultations couldn’t explain such symptoms. Neurological examination did not show any worsening as compared to previous visits. Diagnosis of RGS was suspected. A rotigotine patch 2 mg daily had been prescribed.

Results: Upon follow-up, he showed obvious improvement regarding severity , as well as frequency, of these attacks, with up to 3 weeks symptom-free periods in-between. At a later visit, unexpectedly, he showed a relapse of RGS symptoms, as the patient had run out of the patches few days ago. Improvement was regained back upon reusing the patches.

Conclusion: It is important to keep RGS in mind –however rare- in any case with unexplained genital discomfort sensations. A dopamine agonist agent would be of benefit in relieving these symptoms.

References: Camila C.A, Tiago M., Anthony E.L. Restless Genital Syndrome in Parkinson Disease. JAMANeurol.71(12):1559-1561,2014.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/restless-genital-syndrome-in-a-patient-with-dementia-with-lewy-body/