Lhermitte's Sign (and MS): What It Is and How to Treat It
Multiple sclerosis (MS) is an autoimmune disorder that affects the central nervous system. Nerve fibers are covered in a protective coating called myelin in a normal nervous system. In someone with MS, the immune system attacks the nerve fibers, destroying the myelin and damaging the nerves. The damaged nerves can’t relay messages as well as healthy nerves, which causes a variety of physical symptoms. Lhermitte’s sign, also called Lhermitte’s phenomenon, is a symptom often associated with MS.
Lhermitte’s Sign: Origins
Lhermitte’s sign is a type of nerve pain. The phenomenon was first documented in 1924 by French neurologist Jean Lhermitte. The physician consulted on a case of a woman who complained of stomach pain, diarrhea, poor coordination on the left side of her body, and an inability to rapidly flex the right hand. These symptoms are consistent with what is known today as multiple sclerosis. The woman also reported an electric-like sensation in her neck, back, and toes. This strange symptom was later named Lhermitte’s syndrome.
Lhermitte’s sign is caused by “inappropriate” communication between the nerves that are no longer coated with myelin. Although Lhermitte’s sign is common in MS, it’s not exclusive to the disease. People who have spinal cord injuries or inflammation, such as cervical spondylitis or disc impingement, might also feel the shock-like symptoms of the condition. Severe vitamin B12 deficiency can also be a rare cause of Lhermitte’s sign.
The main symptom of Lhermitte’s sign is a shock-like sensation that travels down your neck and back. The spark of electricity is present in the arms, legs, fingers, and toes. The pain is strongest when you bend your neck forward, as if tucking your chin to your chest. The shock-like feeling is usually short and intermittent, although it can be quite powerful while it lasts.
The primary trigger for Lhermitte’s sign is moving your neck the “wrong” way. Bending your head to your chest could trigger the prickly pain of an electrical shock. Twisting your neck in any unusual way may also produce symptoms. Other triggers can include being tired or overheated. MS symptoms, particularly if you have the relapsing-remitting form of the condition, often worsen in times of physical or emotional stress. Take care of yourself by getting plenty of sleep, staying cool, and monitoring stress levels to prevent an increase of symptoms.
Medications can treat the symptoms of Lhermitte’s sign. Anti-seizure drugs help control the electrical impulses that run through your body to manage the pain. Your doctor might prescribe steroids if Lhermitte’s sign is part of a general MS relapse. You might also take medication to relieve the burning discomfort of nerve pain that is common in people with MS.
Transcutaneous electrical nerve stimulation (TENS) is an effective treatment for some Lhermitte’s patients. TENS produces an electrical charge of its own to reduce inflammation and pain for a number of medical conditions.
Your healthcare team may suggest several lifestyle modifications that may make you more comfortable. Because neck movements can exacerbate Lhermitte’s, a brace can keep you from bending your neck too much. A physical therapist might suggest ways in which you can improve your overall posture to help prevent an attack. You might also benefit from deep breathing exercises and stretching exercises—under the supervision of your doctor, of course—to take the edge off the pain.
Incidence and Outcome
According to the Multiple Sclerosis Foundation (MSF), approximately 38 percent of MS patients will experience Lhermitte’s sign at one time or another. Through a combination of medication, posture adjustments and monitoring, and relaxation techniques, people with MS may be able to keep Lhermitte’s symptoms to a minimum.
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