Objective: To report a case of a multiparous pregnant woman with severe restless legs syndrome (RLS) in her seventh pregnancy who was treated with a low dose of clonazepam, with a good clinical outcome.

Background: RLS is a common sleep disorder in pregnancy. Studies have shown that the prevalence of RLS correspond with parity and occurs more frequently in the second and third trimester of pregnancy. Some studies associate it to numerous adverse pregnancy outcomes.

Method: A single case report.

Results: We present a 44-year-old seventh time multiparous pregnant woman in her 24th week of pregnancy with severe symptoms RLS that occurred at the beginning of the second trimester. She has had these symptoms in every pregnancy so far, usually starting in the second trimester, with relief of symptoms a few weeks after delivery. There is no record or evidence in the patient’s medical history of obstetric complications, and she gave birth to all six children at full term, vaginally. The patient’s mother and sister also suffer from RLS, and she denies other illnesses in the family. Her past medical history was insignificant, she has not suffered from anemia or kidney disease and there was no history of smoking, alcohol, or recreational drug use before or during pregnancy. Laboratory findings, repeated several times during pregnancy, were normal. Due to borderline values of vitamin D, oral supplementation was carried out. Ultrasonography did not show the presence of deep venous thrombosis in her legs. According to the obstetrician’s recommendation, she was taking diazepam at 10 mg at bedtime, which she used occasionally in previous pregnancies, but without effect. Diazepam was substituted with a minimum dose of clonazepam (0.25 mg at bedtime for first two days, and thereafter 0.5 mg). At a 7-day follow-up, patient reported significant reduction of symptoms with good tolerability of the drug and she did not report any side effects to the received therapy. After four weeks patient reported further relief of symptoms with significant improvement in sleep quality and without drug side effects.

Conclusion: In the case of our patient, clonazepam proved to be a good choice for relieving symptoms of RLS, and using a minimal dose of the drug reduced the possibility of side effects. Comprehensive and proper treatment of pregnant patients often requires the cooperation of multiple specialists.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-clonazepam-on-restless-legs-syndrome-in-a-multiparous-pregnant-woman/