What Is The Lhermitte's Sign and What Does It Mean?
Testing for Lhermitte's sign
What is Lhermitte's?
Written in May 2012 by Anne DiGeorge (awordlover)
In what I am going to try to describe to you, I feel like I'm on that old AAMCO transmission commercial from a few years ago when the actors were trying to describe the noises of their ailing or broken transmissions using a variety of sound effects with their voices. So, here goes!
Lhermitte's sign is a tingly shocking feeling.
No, it is a shooting jolt of electricity, starting at my neck then going down my back.
It can be a sharp burning sensation.
On the other hand, it sometimes feels like a giant numb spot that buzzes if I rub it. (I know...don't rub it!)
Actually, Lhermitte's sign is all these things and more.
It usually starts at the back of your neck and works its way down. Fast. It can stop just as quickly too - anywhere from your back to your arms, spine or the legs. Some people say for them, it starts at their feet and works its way upward, causing a weakness in the legs and possibly walking disturbances for a few seconds upon starting to walk. Like a hesitation before taking a step or two.
The shock sensation doesn’t last long. It is more like a jolt of electricity which can make you jerk a little and usually it is over before you know it.
Many patients kiss it off because it is gone so quickly. It rarely lasts for hours and hours unless you are in a stationary position.
Sometimes it feels like a buzzing or tingling and sometimes it is like a sharp stabbing pain.
I’ve experienced itching and the crawlies - where it feels like something is crawling on my skin.
Sometimes I will have long periods of numbness which doesn’t let me off the hook for pain. Even though I’m numb, I'll still get jolting electric shocks every so often. It's just not continuous. It comes and goes.
Lhermitte's usually happens because of some movement that is different from the position you were just in; the way you move around on your own or when a doctor examines you, wanting to make it happen where he pushes on the back of your neck with your neck bent down a bit. I never understood that part. How many times will I ever be in that position where something will be pushing down on the back of my neck? If you have an underlying medical condition (or disease), of course this is going to hurt!!
The doctor will often say "touch your chin to your chest" and then he will push on the back of your neck (lower head) which will make the sensation happen instantly. I usually dread it when that instruction is given because I know for sure I will get the jolt.
The only reason doctors still do it to me is because I changed specialists when we moved to Florida and had to get all new doctors. Otherwise, for you, once your present specialist has it documented in your chart, there really is no reason to keep doing this each visit.
If you do not have a neurological condition or disc impingement, you will feel no pain when he does this and therefore will not exhibit the Lhermitte's sign. It will be noted like this on your chart: "negative for Lhermitte's."
It doesn't hurt too bad ... until he pushes on it!
Have you ever felt Lhermitte's in your neck or shoulders?
They chat a bit on this video, but some of the info is helpful
- Lhermitte's Sign is named after Jacques Jean Lhermitte, French neurologist and neuropsychiatrist, (1877-1959).
- Lhermitte's Sign is not only found in Multiple Sclerosis.
- Some people have a hard time describing it to their doctors.
- Some people don't even bother telling their doctors because they either they feel it is not important to the reason for their visit, or they forget they have it because they are not feeling it at that very moment.
- An injury to the neck, back or shoulders can set off this sensation.
- Sometimes Lhermitte's Sign can last for months if left untreated or if staying in the same position (example: patient in coma, on vent, in wheelchair with no changes in position).
- Although treatment usually consists of pain medications, there are other alternatives for those who do not want pain meds.
I am my own worse enemy
If I get it too often, it is usually due to my own doing.
You can cause it yourself in everyday actions you take for granted, like:
- Putting the phone between your ear and your shoulder so you can write something down
- Signing your name on a store receipt when you turn your head a certain way
- Sleeping with double pillows which can put your head and neck at an awkward angle
- Sitting in the hairdresser’s chair where a sudden movement or head tilt can set it off
In fact, Lhermitte’s sign is often referred to as Barber Chair syndrome. When the hairdresser wants to cut hair at the back of your neck to get it even, you will be told to bend your head forward or tilt your head down to your chest.
In people who have underlying neurological conditions, this causes an instant Lhermitte's sign.
I have even experienced it when the dentist drilled a tooth and hit a nerve. It sent a jolt from my jaw over to my ear and down the side and back of my neck. I don't know what was worse - the jolt or the unexpectedness of the jolt.
Lhermitte's Sign - the "red" signifies the route of pain
So if the doctor knows you have it, why is the doctor messing with your neck?
Actually he is building a symptom list so he can make sure you get the correct diagnosis. Don't be afraid to tell him to quit testing for the Lhermitte's sign, especially if he asks to do it on each visit. Just say no. Tell him he already has information in your chart and you still have the same sensations.
Sometimes repeated testing over a short period of time will aggravate this and cause it to stick around for a while. Patients have been known to hit NSAIDS and even harder medications when NSAIDS didn't kick the pain.
At one point, I had Lhermitte's symptoms for going on seven years because of the way I had to sit in my wheelchair while at work and at home. It also didn't help that I was sitting in front of a computer for four or more hours a day. Like I said, I'm my own worse enemy and I know it. I often said I'd only be an hour or so on the computer and the next thing I know four hours or more has gone by. It is only when I went to change positions, wheel from one room to another, or transfer from the wheelchair that I got the "jolt."
Sedentary positions where you have to hold your head straight or when you don't take frequent breaks will often aggravate Lhermitte's so that it feels like it will never go away. So if you have it for long periods, now you know how to help it.
If your doctor pinpoints the cause after building his symptom list, he may offer to treat your Lhermitte's symptoms. If you want him to, that is.
Sometimes it is better to live with something like this than it is to take medication for it, because one medication leads to another (because of side effects, etc.) and before you know it, you have five medications to treat one thing.
If confronted with taking a prescription medication for symptoms of Lhermitte's which comes and goes, I would skip it and concentrate on getting to the bottom of what is causing Lhermitte's and treat that. Prescription pain medications will decrease your sensitivity to pain and if you are still in diagnosis stage, these meds can mask, making it harder for your doctor to figure out the main diagnosis. So that is why I would advise anyone to skip taking prescription pain meds (hard drugs) for Lhermitte's until you get a name for your overall diagnosis. Use over the counter stuff like NSAIDS or Ibuprofen which won't mask as badly as prescription drugs.
When your doctor documents the Lhermitte’s symptom in your chart and adds it to other symptoms, he then will start looking for a cause by ordering imaging tests and other laboratory studies.
Lhermitte's sign is almost always associated with Multiple Sclerosis, but it is not solely attributed to Multiple Sclerosis.
This means it is not "disease specific."
It can occur in a number of cervical, neurological diseases and disorders. So don't assume right off the bat that you have MS unless it is confirmed by bloodwork and other imaging tests.
I developed a very stubborn case of Lhermitte's when I was in a car accident at around age 13 which resulted in several bulging discs and two herniated discs. No matter what I did, the Lhermitte's symptom would not calm down. Because of the disc damage, I developed painful Arnold-Chiari malformation which caused my neck to crack often (and I thought loudly!). Even though Lhermitte's was present, I did not yet have MS. I was diagnosed with Multiple Sclerosis ten years later. Because I had Lhermitte's a full ten years before MS diagnosis, it made diagnosing MS a little harder. It was also in the days before they had MRI's. In fact, CT scans were brand new -- one CT scan machine took up a 12 x 18 foot room. Now they are more than half that size.
So if you have herniated discs, Arnold-Chiari malformation, any cervical spinal cord injuries or inflammations that could indicate disc problems, chances are you already know what Lhermitte's sign feels like. Now it has a name.
When the doctor is compiling his list of symptoms, he will look for Lhermitte’s sign in patients where he suspects
- Arnold-Chiari malformation
- disc subluxation
- transverse myelitis
- tuberculosis of the cervical spine
- tumors of cervical spinal cord
- Behcet’s disease - when joint pain is present
- radiation myelitis - spinal cord injury after having radiation treatments
- tethered cord syndrome (TCS)
- lipomas of the spinal cord
- lesions on the spinal cord related to other diseases
Lhermitte's is sometimes seen in patients who are undergoing high dose chemotherapy and those who have a significant Vitamin B-12 deficiency, but rarely.
Lhermitte's is not the defining symptom to make a diagnosis - it is a contributing symptom, added to the list. It is not a definitive symptom for diagnosis of any one disease. Even though it is usually associated with MS, as you can see it is a symptom used to diagnose other disorders too.
Treatments for Lhermitte's symptoms
Treatment of Lhermitte's
You would do well to avoid fatigue and getting overheated because it aggravates it and can cause this sensation to flare up. The more overheated you get, the longer it will take for the sensation to calm down. That includes vigorous exercise, hot baths and heating pads.
If you are fatigued, taking to your bed or lying on the sofa for four or more hours has been known to alleviate or slow down the reoccurence of the symptoms. Sometimes you can move just the wrong way and feel that jolt of electricity shooting from your neck down your arm and you'll think you are having symptoms of a heart attack. Rest assured, you are not having a heart attack, this is a neurological symptom.
In some cases, the drugs used to treat Lhermitte's Sign are actually designed for something else entirely. When prescribed for a condition not listed in the literature, this is called using the drug "off label."
Anticonvulsants treat epileptic seizures but have proven effective in treating Lhermitte's. Examples are: Neurontin (Gabapentin) or Lyrica. These drugs block abnormal electrical signals in the brain to cut down on that jolt of electricity you feel.
Some physicians order a rigid neck collar or brace that will limit your range of motion so that you can't change your position very quickly thus triggering Lhermitte's symptoms. Just make sure your doctor keeps up with your physical therapy consults so that your neck doesn't get weak or lose what range of motion you already have.
TENS unit - This didn't work very well with me, but some people report good results. A TENS unit is a transcutaneous electric nerve stimulation machine with a battery pack about the size of a transistor radio (if you are old enough to remember what they are!). It has electrodes attached to sticky pads that you stick onto the painful area and it sends a small electrical throbbing charge to the nerves which is supposed to block pain receptors and, in turn, cut down on the pain of Lhermitte's symptoms. For me all it did was stir up the jolting and jerking sensations, so I soon abandoned it as a form of therapy. It may work for you, I'm just saying it didn't work for me.
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Final thoughts with awordlover
I hope this article has given you some new information in how to deal with the symptoms of Lhermitte's. Thank you for visiting my hub.
May 2012 by awordlover
Updated 3/16/2014 by Rachael O'Halloran to provide attribution to photos and include copyscape logo.
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