Objective: To report the case of a man with restless legs syndrome (RLS) manifesting as predominantly gastrointestinal discomfort.

Background: RLS is an unpleasant urge to move the legs, which starts or worsens with rest, is relieved by movement, and worsens during the evening.[1] Other associated phenomena have become recognized including restless abdominal wall or pelvic muscles.[2,3] A case of restless bladder has been reported, but to our knowledge, no other visceral organ involvement has been described.[4]

Method: We report a single case of presumed restless gut phenomenon experienced by an individual seen at the University of Alabama at Birmingham Movement Disorders Clinic.

Results: A 75-year-old man presented after 5 years of nocturnal bloating, periumbilical discomfort, and increased borborygmus. When his symptoms of abdominal discomfort were maximal, he experienced leg twitching and “drawing up.” To a lesser extent, he also experienced restless symptoms in his legs. His symptoms were relieved by drinking water, pressing on his abdomen, performing a Valsalva, or walking. Passing flatus or stool was also helpful but not commonly possible. GI workup including EGD and colonoscopy was normal. Neither changes in diet nor timing of meals impacted symptoms. Ferritin level was 130 ng/mL. Gabapentin brought relief initially, but benefit waned. He trialed carbidopa/levodopa with complete remission of symptoms.

Conclusion: Although RLS has typically been associated with skeletal muscle movements including abdominal and pelvic wall muscles, we suspect that the nocturnally present visceral GI discomfort in this patient with RLS was the result of a restless gut phenomenon given his complete relief from carbidopa/levodopa and lack of an alternative explanation.

References: 1. Allen, Richard P., et al. “Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria–history, rationale, description, and significance.” Sleep medicine 15.8 (2014): 860-873. 2. Pérez-Díaz, Hernando, et al. “Restless abdomen: a phenotypic variant of restless legs syndrome.” Neurology77.13 (2011): 1283-1286. 3. Baiardi, Simone, et al. “A restless abdomen and propriospinal myoclonus like at sleep onset: an unusual overlap syndrome.” Case Reports 2015 (2015): bcr2014206679. 4. Suzuki, Keisuke, et al. “Restless Bladder in an Elderly Woman: An Unusual Feature or a Variant of Restless Legs Syndrome?.” Internal Medicine 55.18 (2016): 2713-2716.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-diurnally-variable-gut-discomfort-in-a-patient-with-rls/