Objective: Present a patient with Restless Leg Syndrome after propranolol administration

Background: Restless Leg Syndrome (RLS) is an involuntary need to move the lower extremities or other body parts with an unpleasant feeling. This situation leads to sleep disturbances, and decreases the life quality (1,2). Iron depletion, hormonal fluctuations, systemic diseases and medications cause or exacerbate the symptoms (1,3). They include neuroleptics, antidepressants, selective serotonin re-uptake inhibitors, and anti-epileptics (4). Recently, β-blockers have been revealed to induce RLS; even though its exact mechanism has not been conclusively proven (5).

Method: Case report

Results: A 36-year female admitted with complaints of involuntary need to move the lower extremities for a month. She stated this urge became more prominent at night due to immobility, and a temporary relief arose after the physical activity. Her medical history revealed she had migraine for five years, occasionally in compliance with visual aura with positive symptoms. She took 365mg/day of magnesium for migraine prophylaxis; however, the attacks persisted. Recently, she was suffering a headache occurring on 10days/month for more than four months. Due to the diagnosis of Chronic Migraine, she was administered propranolol 40mg three times a day. Even though her migrainous attacks relieved, she started to experience these involuntary movements after the administration. She had not taken any medication recently that might cause these movements and revealed no family history. Her neurological and ophthalmological investigations were normal. Complete blood count, hematology, and urinary tests were in normal ranges. Serum iron level was 100mg/dL, and ferritin was 82µg/L. Her cranial magnetic resonance imaging did not reveal any intensity changes. Based on her medical history, laboratory, neurological evaluation, she was diagnosed with Restless Leg Syndrome (RLS). We discontinued the propranolol treatment and followed her up without medication. Within two weeks of follow-up, her symptoms regressed remarkably. She did not need a treatment for RLS; however, amitriptyline 10mg/day was initiated for migraine prophylaxis, and currently, she has no complaints.

Conclusion: This case highlights the need to consider propranolol as a potential drug to develop RLS. Further researches are needed to establish its adverse effects.

References: 1. Trenkwalder C, Allen R, Högl B, Clemens S, Patton S, Schormair B, et al. Comorbidities, treatment, and pathophysiology in restless legs syndrome. Lancet Neurol. 2018;17(11):994-1005. 2. Koo BB, Bagai K, Walters AS. Restless Legs Syndrome: Current Concepts about Disease Pathophysiology. Tremor and Other Hyperkinetic Movements. Published online July 25, 2016:Tremor and Other Hyperkinetic Movements. doi:10.7916/D83J3D2G 3. Khan FH, Ahlberg CD, Chow CA, Shah DR, Koo BB. Iron, dopamine, genetics, and hormones in the pathophysiology of restless legs syndrome. J Neurol. 2017; 264(8), 1634-1641. 4. Mansur A, Castillo PR, Rocha Cabrero F, et al. Restless Leg Syndrome. [Updated 2020 Oct 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. 5. Panda AK, Pandey S. Identifying risk factors for restless leg syndrome. Neurol India 2019;67:660-1

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