New insights into DAWS, a rare and severe neurological syndrome

Professor Michaël Gillon, FNRS research director at the University of Liège, an astrophysicist also holding degrees in biology and biochemistry, publishes in Frontiers in Human Neuroscience, as a patient-author, the first detailed report of a severe dopamine agonist withdrawal syndrome (DAWS) in a person with restless legs syndrome (RLS), a common and generally benign neurological condition. This report demonstrates that DAWS can, in rare cases, reach extreme and potentially life-threatening severity outside Parkinson’s disease, highlights the possible amplifying role of intense relational stress, and explores the hypothesis of a kindling-like mechanism, whereby repeated withdrawals and stressors may progressively sensitize the nervous system and contribute to more severe and persistent symptoms. 

A rare but dramatic syndrome

DAWS is a rare, still poorly understood, but formidable complication that occurs upon discontinuation of dopamine agonists, a class of drugs that stimulate dopamine receptors in the brain. Its symptoms are multiple and severe: uncontrollable anxiety, agitation, neuropathic pain, insomnia, atypical sensory disturbances, profound depression, and persistent suicidal ideation.

Until now, DAWS had been described primarily in patients with Parkinson’s disease, often at high doses. A few isolated cases had been reported in restless legs syndrome, but they remained exceptional and relatively mild. This new report is the first to show that DAWS can be severe, prolonged, and profoundly disabling, even at low doses, outside the context of Parkinson’s disease.

A possible kindling-like dynamic

The report describes the course of DAWS leading to a major and lasting neurological collapse, marked by repeated hospitalizations and exacerbations often coinciding with episodes of intense relational stress. Each withdrawal attempt, sometimes followed by medication reintroductions, appeared to reinforce the severity of the condition, in a process comparable to kindling: the progressive hypersensitization of the nervous system in response to repeated stimulations. This is an accumulation effect — with each relapse or stress, the nervous system becomes more vulnerable and reacts more violently. This dynamic may explain the unusual severity and persistence of symptoms.

The importance of psychosocial support

This case suggests that DAWS severity does not result solely from the molecule or the prescribed dose, but also from the psychosocial context. Under this hypothesis, an appropriate relational environment could prove essential in limiting suffering and preventing the high suicidal risk associated with this syndrome.

Medications with underestimated risks

Dopamine agonists remain effective for relieving symptoms of restless legs syndrome, at least initially. But their risks are now better documented. In addition to DAWS, they can paradoxically worsen the very condition they are intended to treat after prolonged use. They may also induce compulsive and sometimes destructive behaviors. These side effects highlight the need for clear patient information and close monitoring whenever these drugs are prescribed.

A message for the medical community and patients

“I chose to testify scientifically in order to raise awareness not only within the medical community but also among patients who may be prescribed dopamine agonists, about the existence of DAWS and its potential severity,” explains Michaël Gillon. “My hope is that this report will help others avoid going through what I had to endure.”

Beyond this testimony, the publication highlights a genuine blind spot in modern medicine: the lack of recognition, research, and training regarding withdrawal syndromes associated with certain neurological treatments, particularly dopamine agonists. Although potentially severe and disabling, these syndromes remain too often poorly identified, misdiagnosed, or wrongly attributed to psychiatric disorders or to the recurrence of the neurological condition that the treatment was intended to relieve. Better patient information and careful clinical follow-up are essential to prevent unnecessary suffering and avoidable tragedies.

Reference

Gillon, Case Report: Prolonged Dopamine Agonist Withdrawal Syndrome (DAWS) in an RLS Patient Under Severe Relational Stress, Frontiers in Human Neuroscience (2026), https://doi.org/10.3389/fnhum.2025.1613710

Contact

Michaël Gillon –  Research Director, Fund for Scientific Research – FNRS, ULiège, Astrophysics, Geophysics and Oceanography Department, Research Group ExoTIC  - michael.gillon@uliege.be – +32 473 34 64 02