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Lhermitte's Sign

By: MSF Staff and reviewed by the Multiple Sclerosis Foundation Medical Advisory Board

Lhermitte’s sign (also known as Lhermitte’s phenomenon) is the name given to a brief electric shock-like sensation that occurs when flexing or moving the neck. This sensation radiates down the spine, often into the legs, arms, and occasionally, the trunk.

At some point, about 38% of individuals with MS will experience Lhermitte’s sign, sometimes as a presenting symptom. Lhermitte’s sign was named after Jacques Jean Lhermitte, the renowned French neurologist and neuropsychiatrist who first characterized it.

Lhermitte’s sign is not specific to MS. It is a symptom that can occur with any abnormality of the cervical spinal cord, usually involving active inflammation or impingement on a disc. It can occur with vitamin B12 deficiency, cervical spondylosis, and other conditions. An MRI may be required to rule out other possible causes. In MS, Lhermitte’s sign is a classic form of neuropathic pain.

Fatigue, overheating, or simply moving the wrong way can cause a flare up of this uncomfortable symptom. If you are experiencing symptoms of Lhermitte’s sign, discuss them with your doctor.

MEDICAL TREATMENT

Medications are available to treat spasticity, pain, and dysesthesias (sensations of burning, tingling or numbness) in MS. Some of the currently available treatments include anti-convulsants (Neurontin®, Trileptal®, Tegretol®, Gabitril®, Lyrica®), antispastic agents (Klonopin, Baclofen), antidepressants (Elavil, Cymbalta), sodium channel blockers (Mexilitine) and steroid therapy (if Lhermitte’s sign is part of an acute relapse).

OTHER TREATMENT OPTIONS

Electrical stimulators may be of benefit to some individuals. This includes external devices, such as TENS units (transcutaneous electrical nerve stimulation) or implantable units, such as dorsal column stimulators. These therapies may actually block pain impulses. A physical therapist may prescribe a soft neck brace or collar to help with posture and positioning of the head. If a neck brace or collar is used, periodic monitoring is required to ensure that strength and range of motion is not compromised. An occupational therapist may offer progressive muscle relaxation techniques, deep breathing exercises, and active or passive stretching.

“Although many of the treatmentsfor Lhermitte’s are anti-convulsants, Lhermitte’s is not a seizure,” clarifies MSF Medical Advisor, Dr. Ben Thrower. “It is likely that Lhermitte’s represents inappropriate ‘cross-talk’ between demyelinated axons. Many anti-convulsants work to control the abnormal electrical signals in the brain. It is this mechanism of action that may make such medications useful for spinal cord symptoms like Lhermitte’s.”

(Last reviewed 7/2009)



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Unless otherwise specified, all medical content is compiled by MSF staff and reviewed for accuracy by a member of our Medical Advisory Board.

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