Diagnostic challenges in restless abdomen syndrome: A case report

Table 1 Polysomnography findings before and after treatment

Parameters	Before treatment	After treatment
Total sleep time (minutes)	335	460
Sleep efficiency (%)	75.2	95.2
Sleep latency period (minutes)	55	10
N1 stage (%)	7.3	5.6
N2 stage (%)	69.8	55.8
N3 stage (%)	10.2	23.5
R stage (%)	12.7	15.1
Apnea-hypopnea index (events/hour)	8.8	8.5
Periodic limb movement index (events/hour)	37.7	8.5

Table 2 Summary of reported restless abdomen cases and clinical characteristics (2020-2025)

Ref.	Patient (age/sex)	Core symptoms	Leg involvement?	Key investigative findings (iron and PSG)	Treatment and outcome	Distinctive features
Vijayan et al[14], 2025	1 (23 years, F)	Deep “swirling” sensation in the left upper abdomen, urge to move, and severe insomnia, no family history of RLS	No	Iron: Not reported; PSG: Not performed; Vitamin D3: Low	Pramipexole (0.125 mg/day); complete resolution	Very young onset; diagnosed in a psychiatry setting; lacks objective PSG/iron data
Sun et al[13], 2022	1 (60 years, M)	Unpleasant abdominal sensations begin approximately 30 minutes after lying down, relieved by rubbing, slapping the abdomen, or walking; caused difficulty falling asleep; no mention of family history	No	PSG (video): Documented urge to move abdomen during rest and periodic limb movements of sleep (PLMS); labs: Hemoglobin, iron, ferritin normal; imaging: GI endoscopy and abdominal CT normal; genetic testing: Not performed	Pramipexole (0.25 mg/day); good response over 8 months of treatment	High-quality video evidence of urge to move; classic isolated phenotype with normal iron
Wang et al[7], 2020	10 (mean: 68.8 years, 8 F/2 M)	Sensations: Itching, crawling, numbness, soreness; all showed classic RLS circadian/rest-activity patterns; family history: 1/10 (10%) positive	Yes (7/10); no (2/10); chest (1/10)	Iron: Low in 50% (ferritin < 75 or TSAT < 20%); PSG: PLMS confirmed (in 3 tests); mean IRLS 27.7 (moderate-severe); genetic testing: Not reported	Dopaminergic therapy (pramipexole 0.25 mg/day) alone or combined with gabapentin; positive response in all patients	Largest series; shows isolated abdominal RLS is rare (20%); high prevalence of iron deficiency
This case	1 (55 years, F)	Nocturnal abdominal discomfort, irresistible urge to move, severe anxiety and insomnia; no family history of RLS	No	Iron: Normal ferritin; transferrin: Low (1.83 g/L); PSG: PLMI 37.7 events/hour; imaging: GI endoscopy, abdominal CT and cranial MRI normal; genetic testing: Not performed	Pramipexole (0.25 mg/day); good response over one week; sustained remission (1-year follow-up)	Combines key features: (1) Isolated abdominal phenotype; (2) Objective PSG confirmation; (3) Unique biomarker finding (isolated low transferrin); and (4) Documented long-term efficacy; suggests a potential distinct biochemical correlate

M: Male; F: Female; RLS: Restless legs syndrome; IRLS: International restless legs syndrome study group rating scale; PLMS: Periodic limb movements in sleep; PLMI: Periodic limb movement index; PSG: Polysomnography; CT: Computed tomography; GI: Gastrointestinal; MRI: Magnetic resonance imaging; TSAT: Transferrin saturation.