Objective: To identify restless abdominal syndrome as a potential cause of abdominal discomfort in patients presenting with discomfort in abdominal area which gets worse at night.

Background: Restless leg syndrome (RLS) / Willis-Ekbom disease (WED), is a movement related circadian sleep disorder, characterized by insomnia due to unpleasant sensation in lower extremities with an urge to move the legs. Involvement of other body parts is uncommon. There have been few cases of phenotypic variant of RLS with abdominal presentation reported before (1-2). Here we are presenting a case of restless leg syndrome that evolved to restless abdominal syndrome, specifically responding to dopaminergic therapies.

Method: Case: A 52-year-old Hispanic male with family history of RLS in mother and past medical history of restless leg syndrome for 15 years, who presented with chief complaint of unpleasant feeling on his abdominal area for the past 6 months. Patient describes it as an unpleasant discomfort sensation localized to his abdomen, mostly when he is lying down in bed, improves with any physical activity, particularly with “shaking the abdomen”.

Results: Patient was seen in internal medicine clinic, blood work and abdominal imaging did not reveal any abnormalities and colonoscopy was normal. Patient was initially started on a trial of gabapentin 100 mg twice a day with up titration to 300 mg twice a day with no response, however, a low dose of dopamine agonist treatment (pramipexole 0.25 mg daily) relieved the symptoms.

Conclusion: Restless abdominal syndrome is a rare variant of RLS which can present with unpleasant abdominal symptoms exacerbated at night and when lying down, accompanied by an urge to move. Patients may report insomnia due to these abdominal symptoms. Unlike classic RLS, restless abdomen syndrome may not respond to first-line treatments like gabapentin. It is important for clinicians evaluating patients with abdominal discomfort to be aware of this syndrome as a potential cause, especially when symptoms are worse at night. Identifying and treating this disorder with appropriate dopaminergic medications can significantly improve patients quality of life and avoid unnecessary invasive diagnostic procedures.

References: 1- Pérez-Díaz, H., Iranzo, A., Rye, D.B. and Santamaría, J., 2011. Restless abdomen: a phenotypic variant of restless legs syndrome. Neurology, 77(13), pp.1283-1286.
2- Wang, X.X., Zhu, X.Y., Wang, Z., Dong, J.W., Ondo, W.G. and Wu, Y.C., 2020. Restless abdomen: a spectrum or a phenotype variant of restless legs syndrome?. BMC neurology, 20(1), pp.1-7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-restless-abdominal-syndrome-an-uncommon-variant-of-restless-leg-syndrome/