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Case Reports
. 2021 Jan-Dec:12:21501327211019590.
doi: 10.1177/21501327211019590.

Challenges in the Treatment of Restless Legs Syndrome: A Case Report

Audrey Umbreit  1 , Shirshendu Sinha  1   2 , Bhanu Prakash Kolla  2 , Meghna P Mansukhani  2
Affiliations
Case Reports

Challenges in the Treatment of Restless Legs Syndrome: A Case Report

Audrey Umbreit et al. J Prim Care Community Health. 2021 Jan-Dec.

Abstract

Treatment resistant restless legs syndrome (RLS) in the setting of psychiatric comorbidities can be difficult to manage. Our patient is a 69-year-old Caucasian gentleman with bipolar disorder type I, unspecified anxiety disorder, obstructive sleep apnea (OSA), and treatment-refractory RLS. At initial presentation, the patient's prescribed medication regimen included fluoxetine 40 mg daily, gabapentin 800 mg in the morning and 3200 mg at bedtime, pramipexole 0.375 mg daily, lamotrigine 200 mg daily, trazodone 200 mg at bedtime, and temazepam 15 to 30 mg as needed for insomnia and RLS. Over the course of nearly 4 years, treatment interventions for this patient's RLS included: cognitive behavioral therapy for insomnia, discontinuation of exacerbating medications, switching dopamine agonists, use of pregabalin and iron supplement. This report demonstrates a challenging case of RLS in the setting of psychiatric comorbidities, development of augmentation, and polypharmacy.

Keywords: case report; medications; mood disorder; psychiatry; restless legs.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The publication of this article was funded by a research grant from the Mayo Midwest Pharmacy Research Committee.

Figures

Figure 1.
Figure 1.
Timeline of medication changes.
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References

    1. Yeh P, Walters AS, Tsuang JW. Restless leg syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath. 2012;16:987-1007. - PubMed
    1. Stefansson H, Rye DB, Hicks A, et al.. A genetic risk factor for periodic limb movements in sleep. N Engl J Med. 2007; 357:639-647. - PubMed
    1. Miyamoto M, Miyamoto T, Iwanami M, Suzuki K, Hirata K. Pathophysiology of restless legs syndrome. Brain Nerve. 2009;61:523-532. - PubMed
    1. Winkelmann J, Allen RP, Högl B, et al.. Treatment of restless legs syndrome: evidence-based review and implications for clinical practice (revised 2017). Mov Disord. 2018;33:1077-1091. - PubMed
    1. García-Borreguero D, Allen RP, Kohnen R, et al.. Diagnostic standards for dopaminergic augmentation of restless legs syndrome: report from a World Association of Sleep Medicine-International Restless Legs Syndrome Study Group consensus conference at the Max Planck Institute. Sleep Med. 2007;8:520–530. - PubMed

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