CASE REPORT article
Front. Hum. Neurosci.
Sec. Brain Health and Clinical Neuroscience
Volume 19 - 2025 | doi: 10.3389/fnhum.2025.1613710
This article is part of the Research TopicThe Advance on Sleep Disorder: Mechanisms and InterventionsView all 9 articles
Case Report: Prolonged DAWS in an RLS Patient Under Severe Relational Stress
Provisionally accepted- University of Liège, Liège, Belgium
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Background: Dopamine agonist withdrawal syndrome (DAWS) is a severe condition reported primarily in Parkinson's disease (PD) but increasingly recognized in restless legs syndrome (RLS). While DAWS is classically associated with high-dose dopamine agonists (DAs) in Parkinson's disease, it has also been reported in RLS patients treated with low-dose therapy (≤0.75 mg pramipexole equivalent), although such cases remain rare. Although direct evidence is lacking, psychological and relational stressors, in conjunction with prior medication adjustments, could plausibly modulate DAWS severity through a mechanism akin to kindling. Case Presentation: We describe the case of a 51-year-old male who developed severe DAWS after withdrawing from low-dose pramipexole (0.26 mg) prescribed for RLS. A six-month venlafaxine taper (112.5 mg/day to 0), completed two weeks before DA tapering, may have increased neurochemical vulnerability. Initial dose reduction caused akathisia, tremors, panic attacks, RLS worsening, and depressive symptoms. After brief reinstatement, abrupt cessation triggered painful electric-like sensations in the lower back and emotional collapse. The patient was transitioned to rotigotine (2 mg/day), in combination with other psychotropic medications, which provided partial and temporary relief. Symptoms relapsed during tapering, with significant worsening observed in parallel with a psychologically destabilizing romantic relationship. Clinical evaluations later characterized the relationship as emotionally abusive, and suggested it may have contributed to the severity and recurrence of DAWS episodes. At 11 months after complete DA discontinuation, the patient has regained nearly full functionality and mental clarity, although episodes of marked fatigue and significant bedtime RLS persist. Discussion and Conclusion: This case illustrates that DAWS can occur in RLS patients even at low DA doses, with atypical symptoms possibly involving autonomic and central sensitization. Relational stress appears to significantly exacerbate symptom severity, potentially leading to profound neurological destabilization through mechanisms such as cross-system hypersensitivity or a kindling-like process, as suggested by existing literature. This factor may need to be systematically assessed in DAWS management. As a rare patient-authored account, this report contributes to the understanding of DAWS in non-PD populations and highlights the need for longitudinal research to guide safer withdrawal protocols and integrated care.
Keywords: Dopamine agonist withdrawal syndrome, Restless Legs Syndrome, pramipexole, rotigotine, central sensitization, traumabonding, Relational stress, Neurochemical sensitization
Received: 29 Apr 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Gillon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Michaël Gillon, University of Liège, Liège, Belgium
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