Successful treatment of abnormal sensation associated with restless legs syndrome in adrenoleukodystrophy using Gunggwijohyeoleum-Jeilgagam: A case report.

BACKGROUND

Adrenoleukodystrophy (ALD) is a rare neurodegenerative disorder frequently associated with restless legs syndrome (RLS), particularly in patients with the adrenomyeloneuropathy (AMN) phenotype. RLS can markedly aggravate abnormal sensations, insomnia, and gait dysfunction; however, conventional treatments, such as dopamine agonists or iron supplementation, are often ineffective or inappropriate, especially in patients without iron deficiency. Herein, we report the clinical effects of herbal medicines in a patient with ALD-associated refractory RLS.

CASE PRESENTATION: A 50-year-old Asian man with genetically confirmed AMN-type ALD presented with a 10-year history of persistent tingling and discomfort in both lower extremities, severe RLS, insomnia, and progressive gait impairment. Despite treatment with baclofen and pramipexole, his symptoms remained refractory, with an International Restless Legs Syndrome Rating Scale (IRLS) score of 31, a Short Physical Performance Battery (SPPB) score of 4, and sleep duration limited to 2-3 h per night. The serum ferritin level was 140 μg/L, indicating adequate iron stores. Based on Korean medicine (KM) pattern identification, the herbal prescription Gunggwijohyeoleum-Jeilgagam (GJG) was administered for 21 days. Following treatment, the IRLS score decreased from 31 to 13, falling below the threshold for severe RLS, while the SPPB score improved from 4 to 6. The sleep duration increased to 5 h, and these improvements were maintained for 5 months after discontinuation without recurrence.

CONCLUSIONS

GJG demonstrated potential benefit in alleviating refractory RLS-associated abnormal sensations and improving physical function in a patient with ALD. This case suggests that KM may represent a complementary therapeutic option for chronic sensory, sleep, and functional impairments in neurodegenerative disorders when conventional treatments are insufficient.