What is Lhermitte's Sign?

Lhermitte’s sign is a short, intense sensation that feels similar to an electric shock passing down the neck and spine and radiating through the trunk and limbs.

It can occur with multiple sclerosis (MS), but it can also affect people who do not have MS.

Some people refer to Lhermitte’s sign as the barber chair phenomenonTrusted Source because it can happen when a person bends their head forward rapidly.

Those who have experienced the sensation have likened it to an electric shockTrusted Source. It results from the stimulation of irritated nerves or the spinal cord and causes a similar sensation to hitting the elbow or “funny bone.”

In this article, we look at why Lhermitte’s sign happens and how it relates to MS. We also discuss the treatment options and explain when someone should see a doctor about this symptom.

Causes of Lhermitte’s sign

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Lhermitte’s sign most often occurs with MS. MS happens when the body mistakenly attacks the central nervous system (CNS). The CNS comprises the brain and spinal cord.

MS damages the myelin sheath, which is the protective, insulating material that coats the nerve fibers in the brain and spinal cord.

This damage interrupts the flow of signals across parts of the CNS, resulting in a range of sensory and motor symptoms.

There are two main causes of Lhermitte’s sign. The first is demyelination, or damage to the myelin around the nerves. The second is hyperexcitability, which is the increased firing of nerve fibers in the brain.

Miscommunication between damaged nerve fibers can also cause Lhermitte’s sign.

Lhermitte’s sign is present in other demyelinating disorders, such as neuromyelitis optica, which affects the optic nerve and spinal cord.

It can also occur with other medical conditions and treatments that affect the spinal cord in the neck region.

These include:Trusted Source

• spinal cord compression due, for example, to a tumor
• spinal cord injury
• radiculopathy
• cervical spondylitis
• transverse myelitis
• spinal cord degeneration
• some radiation or chemotherapy treatments for cancer
• stopping the use of some antidepressant drugs may increase the risk
• inflammation due to injury or damage to the spinal cord (myelopathy)
• Arnold-Chiari malformation
• Behçet’s disease, a rare autoimmune disorder causing inflammation in the blood vessels
• shingles
• systemic lupus erythematous
• receiving anesthesia or another intervention to the spine
• nitric oxide toxicity
• cervical disk disorders, which affect the top of the spine

Several case studiesTrusted Source have suggested a link between vitamin B12 deficiency and Lhermitte’s sign. Vitamin B12 is necessary for the production and maintenance of myelin, the fatty substance that makes up the myelin sheath and covers nerve fibers.

The findings of a 2015 studyTrusted Source suggest that Lhermitte’s sign affects 1 in 3 people with MS. About 16% of the participants reported experiencing it during their first episode of MS.

Triggers

Lhermitte’s sign can occur when a person flexes their neck — for example, if they bend their neck forward suddenly so that the chin touches the chest.

Other triggers include:

• fatigue
• stress
• exposure to heat

Lhermitte’s sign is different than Uhthoff phenomenonTrusted Source. With Uhthoff phenomenon, the neurological symptoms of MS worsen temporarily on exposure to heat. They may get worse, for example, when using a sauna.

When to contact a doctor

People who experience Lhermitte’s sign for the first time might fear that their MS is worsening, but this is not necessarily the case.

However, it may be a good idea to speak with a doctor, as they may be able to suggest treatment options.

Treatment can help people manage the pain that occurs with Lhermitte’s sign and other MS symptoms.

If Lhermitte’s sign occurs in a person without a diagnosis of MS or another known demyelinating condition, they should consider speaking with a doctor. Lhermitte’s sign can sometimes be an early signTrusted Source of MS.

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Treatment options

Education and reassurance are often enough to help most people manage the discomfort of Lhermitte’s sign. It often goes away after several months to a year.

However, a doctor may recommend treatment if it happens often and significantly affects a person’s quality of life.

Various treatment options may help manage the pain of Lhermitte’s sign and other MS symptoms.

Managing stress

Relaxation techniques can help some people. They include:

• mindfulness and meditation
• deep breathing
• stretching exercises

A doctor can advise on a suitable stretching routine.

Mechanical devices

Wearing a soft neck brace may helpTrusted Source a person avoid neck movements that trigger Lhermitte’s sign.

Electrical stimulating devices, such as transcutaneous electrical nerve stimulation units, use a mild electric current to ease pain. These electrical pulses help reduce the pain signals and relax the muscles.

They may also lead to the production of hormones called endorphins that act as natural pain relievers.

Drugs

There is no specific drug treatment for Lhermitte’s sign, but there is some anecdotal evidence that the following may help:

• carbamazepine (Tegretol)
• oxcarbazepine (Trileptal)
• gabapentin (Neurontin)

Summary

Lhermitte’s sign is an electric shock-like sensation that affects the neck and spine. It is usually sporadic and does not last long, but it may recur. It often resolves without treatment after several months or up to a year.

It can affect people with MS when they make a sudden movement with their neck or head. However, it does not only occur with MS.

Lhermitte’s sign can be bothersome and uncomfortable, but it is not life threatening and does not mean that MS is getting worse.

Anyone with MS who unexpectedly experiences such a sensation may wish to let their doctor know. The doctor may be able to suggest ways of reducing its impact.