Back-localized restlessness without limb involvement: a case with features suggestive of the restless legs syndrome spectrum

Abstract Background Restless legs syndrome (RLS) is typically characterized by unpleasant sensations in the lower limbs and an urge to move the legs. Abnormal sensations localized to the back without limb involvement have been reported as restless back syndrome; however, such presentations do not necessarily fulfill the diagnostic criteria for typical RLS, and their classification requires cautious interpretation. Although associations between RLS and autonomic symptoms, including urinary symptoms, have been reported, the clinical significance of cases in which urinary urgency and generalized heat sensation occur synchronously with back-localized abnormal sensations remains unclear. Case presentation A 50-year-old man presented with a restless and uncomfortable sensation localized to the interscapular region. The symptoms occurred while lying at rest after going to bed, before sleep onset, were accompanied by an urge to move the back or body, and were temporarily relieved by movement. However, he had no urge to move the legs and no limb symptoms. When the symptoms occurred, urinary urgency and generalized heat sensation appeared during the same time period. During ropinirole use, these symptoms were suppressed based on the patient’s report. Subsequently, during acupressure mat use, the back symptoms occurred rarely or not at all, whereas urinary urgency and generalized heat sensation partially persisted. The assessment was based on an online medical history interview and patient-provided materials. Conclusions Although this case cannot be diagnosed as typical RLS, its clinical course may be cautiously interpreted as possible restless back syndrome within the RLS spectrum. The synchronous occurrence of urinary urgency and generalized heat sensation with the back symptoms, as well as the patient-reported improvement of the back symptoms during acupressure mat use, is noteworthy; however, neither finding demonstrates a pathophysiological association or treatment efficacy based on this single case.