Restless Leg Syndrome Following Aripiprazole Discontinuation: A Case Report

Background: Aripiprazole is a second-generation antipsychotic known for its partial dopamine D2 agonist properties, which help reduce the risk of extrapyramidal symptoms. While effective and generally well-tolerated, withdrawal symptoms, such as Restless Legs Syndrome (RLS) and akathisia, have been observed upon abrupt discontinuation in some patients. Objective: To report a rare case of Restless Legs Syndrome (RLS) following the discontinuation of aripiprazole in a patient with a history of substance-induced psychosis. Case Description: A 39-year-old male with a history of polysubstance use in sustained remission, presented with RLS-like symptoms shortly after discontinuing aripiprazole, which he had taken consistently for the last 6 years. The symptoms, which included a pinching sensation in his thighs, involuntary leg movements during sleep, and a sense of restlessness, emerged within 2 - 3 days of medication cessation. These symptoms are resolved within an hour of reinitiating aripiprazole. The patient’s clinical presentation underscores a rare but clinically significant withdrawal phenomenon associated with aripiprazole discontinuation, potentially linked to dopamine dysregulation. Conclusions: This case highlights the importance of recognizing and managing aripiprazole discontinuation symptoms, including RLS. Clinicians should consider a gradual tapering protocol for aripiprazole to minimize withdrawal-related movement disorders and monitor patients for emergent symptoms. Further research is recommended to establish standardized guidelines for managing similar cases.