1313 - A Rare Case of Gabapentinoid-Induced Restless Arms Syndrome

Case Diagnosis: This case highlights a unique presentation of gabapentinoid-induced restless arms syndrome in a middle-aged man admitted to acute inpatient rehabilitation after mid-thoracic laminectomy and intradural tumor resection.

Case Description: A 57-year-old male was admitted to acute inpatient rehabilitation after T4-6 revision laminectomy and intradural tumor resection. During his admission, the patient complained of irresistible urges to move his arms after nightly gabapentin. When present, his symptoms progressed distally to proximally and included a sensation of needing to “tire out the muscles.” He denied any associated pain or weakness, and his symptoms would resolve with oxycodone. The patient endorsed prior trials of pregabalin and gabapentin with similar upper extremity restlessness. While admitted, the patient was transitioned from gabapentin to amitriptyline with complete resolution of his restless arms sensations and successful treatment of his neuropathic pains.

Discussions: Restless arms syndrome as an adverse effect of gabapentin has not previously been reported. In pediatric patients restlessness and hyperactivity are rare reactions, and in adults there are some case reports related to the development of dystonia and chorea from the use of gabapentinoids. Notably, these prior reports highlight involuntary movement disorders whereas this case demonstrates a unique, voluntary movement syndrome. Because of the complete resolution of symptoms with the discontinuation of gabapentin, the source of symptoms can be directly attributed to this medication, and highlights a new, noteworthy adverse effect from its use.

Conclusions: This case represents a rare adverse effect of gabapentin which has previously been unreported in literature. While gabapentinoids can be used to treat restlessness syndromes, this presentation demonstrates the development of restless arms syndrome from their use. Overall, this clinical case highlights the importance of ascertaining key information from a patient’s medical history in order to properly identify precipitating factors for symptoms while making simple yet effective treatment changes.