Multiple Sclerosis and Lhermitte’s Sign: 4 Things To Know | MyMSTeam

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Multiple Sclerosis and Lhermitte’s Sign: 4 Things To Know

Posted on May 17, 2023

Imagine feeling like you’re getting a sudden electric shock every time you move your head or neck — that’s the sensation known as Lhermitte’s sign. Some people living with multiple sclerosis (MS) experience Lhermitte’s sign. Sometimes, Lhermitte’s sign can travel into the arms and legs, too. This unpleasant symptom is typically triggered when you bend your head forward toward your chest. In people living with MS, anywhere from 9 percent to 41 percent experience Lhermitte’s sign.

Members of MyMSTeam have described what it feels like living with Lhermitte’s sign. “Has anyone ever felt like they have stinging in their upper back when they bend downward?” One member asked. “I found out that I have Lhermitte’s sign. I thought I was going crazy bending my head and feeling a buzzing that went from my neck to my spine. I’m going to contact my MS doctor in the morning,” another member added.

Read on to learn about four things to know about Lhermitte’s sign, including what it feels like, what can put you at higher risk of experiencing it, and what treatments may be available to you.

1. Lhermitte’s Sign Is Caused by Nerve Damage

Lhermitte’s sign is considered to be a nervous system pain syndrome associated with MS. It’s named after a French neurologist named Jean-Jacques Lhermitte (1877-1959) who first noticed the symptom (Lhermitte phenomenon) and coined the term. Importantly, Lhermitte’s sign is not a disease itself but rather a symptom. The pain typically feels like an electric shock, comes and goes, and is triggered by neck motion or touching your chin to your chest. It’s usually caused by a lesion or compression in the cervical portion of the spinal cord or the lower part of the brainstem. One study found that 95 percent of people living with Lhermitte’s sign had a lesion in their cervical spinal cord. Lesions or compression in the brain or spinal cord can cause issues with nerve conduction. Problems with nerve conduction can lead to neurons (nerve cells) firing abnormally and occasional bouts of pain.

2. Lhermitte’s Sign Happens With Many Health Conditions

Lhemitte’s sign is not specific to MS — it can be seen in a variety of conditions. Having one of the following conditions (or treatments) can lead to this symptom:

  • MS
  • Radiation treatment
  • High-dose chemotherapy
  • Lupus
  • Disc herniation or degenerative disc disease
  • Herpes zoster infection
  • Transverse myelitis
  • Cervical spinal cord compression
  • Behçet’s disease
  • Arnold-Chiari malformation
  • Trauma
  • Discontinuation syndrome from certain antidepressants
  • Subacute combined degeneration of the spinal cord
  • Spinal cord conditions (e.g., syringomyelia)
  • Vitamin B12 deficiency

Of note, vitamin B12 deficiency –– which can come about from eating a vegan diet and not taking the right supplements –– is something to avoid. If you’re living with MS, eating a healthy and balanced diet is important.

3. There Can Be Triggers for Lhermitte’s Sign

In addition to having a condition associated with Lhermitte’s sign, certain things can trigger the symptom itself. Members of MyMSTeam have described such triggers and how it affects them. “The Lhermitte’s sign (electric shock sensations throughout my limbs) was one of my initial symptoms. Then for a period of time, it would come and go depending on my tiredness. More recently, it has not been present,” one member wrote. Specific triggers may include:

  • Fatigue
  • Stress
  • Heat
  • Yawning
  • Certain neck movements, especially forward flexion (bending of a joint, which decreases the angle between two parts of the body)

4. There Are Ways To Treat Lhermitte’s Sign

If you’re living with MS and Lhermitte’s sign, it can be a painful and unpleasant experience. Fortunately, Lhermitte’s sign usually does not produce severe pain and often goes away on its own. As such, treatment of the underlying condition –– in this case, MS –– is the priority. Although there is no specific treatment for Lhermitte’s sign, there are a few general treatments that can be used to help with the symptom.

Medications

Generally, over-the-counter pain relief medications are the first choice in treating Lhermitte’s sign. If those don’t work, then a short course of oral steroids or muscle relaxants may help. If these options don’t help, medications for neuropathic pain are typically the next step in the treatment plan.

There are several medications on the market to treat nerve (neuropathic) pain, abnormal sensations (numbness, tingling), and spasticity in MS. Some of these medications can be used to treat Lhermitte’s sign, including:

There have been a few reports that certain medications –– specifically, gabapentin, carbamazepine (Tegretol), and oxcarbazepine (Oxtellar) –– can help with this symptom. However, there is not a lot of evidence regarding their effectiveness, and most of the available information is based on personal stories and not on scientific research. Be cautious about jumping to a neuropathic pain medication or anti-seizure medication because many have debilitating side effects.

Therapy

Working with a physical therapist or an occupational therapist can be very helpful if you’re living with Lhermitte’s sign. A physical therapist can help you get fitted for a soft neck brace to help with proper head positioning and posture. Sometimes, such adjustments can help relieve painful symptoms. An occupational therapist can help with proper stretching techniques, muscle relaxation techniques, deep breathing, and mindfulness.

Electrical Stimulation

Electrical stimulator devices –– such as transcutaneous electrical nerve stimulation (TENS) or dorsal column stimulators –– can help some people living with Lhermitte’s sign. TENS is a device worn outside the body, whereas dorsal column stimulators are implantable devices. Surgically implanted spinal cord stimulators are typically done only after conservative treatment and medication therapy haven’t worked in severe cases. These electrical stimulators block pain impulses, thereby relieving symptoms. One small study of people with MS reported that pulsed electromagnetic fields (EMFs) directed at areas outside the skull resolved Lhermitte’s sign. The use of electrical stimulation on the spinal cord to treat Lhermitte’s sign is considered off-label, as it has not been approved by the U.S. Food and Drug Administration (FDA) for this purpose. Always check with your health insurance before undergoing any therapy, as it might not be a covered benefit under your plan.

If you’re experiencing painful, electric shocklike sensations coming from your neck, it’s time to speak to your doctor. Your neurologist can best help you figure out a treatment plan that works to relieve this MS symptom.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 198,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you experienced Lhermitte’s sign while living with MS? Did any type of therapy or treatment work for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on May 17, 2023
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Luc Jasmin, M.D., Ph.D., FRCS (C), FACS is a board-certified neurosurgery specialist. Learn more about him here
Remi A. Kessler, M.D. is affiliated with the Medical University of South Carolina and Cleveland Clinic. Learn more about her here

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