Lhermitte’s sign, also known as Lhermitte’s phenomenon or the "barber chair phenomenon," is a distinctive neurological symptom often associated with multiple sclerosis (MS). It manifests as a sudden, brief, and intense electric shock-like sensation that travels down the spine and into the limbs when the neck is flexed forward. This symptom is relatively common in MS, affecting approximately 33% to 40% of individuals with the condition (MS Focus) (BMJ Journals). Understanding Lhermitte’s sign is crucial for individuals with MS, as it provides insight into the underlying neurological disruptions caused by the disease and offers pathways for effective management.
What Causes Lhermitte’s Sign?
Demyelination: In MS, Lhermitte’s sign is caused by demyelination, which is the loss of the protective myelin sheath around nerves in the spinal cord. This demyelination disrupts normal nerve function, leading to the characteristic shock-like sensations. Demyelination in MS can result from the immune system mistakenly attacking the myelin sheath, causing inflammation and scarring (sclerosis) in the central nervous system.
Cervical Spondylosis: Degenerative changes in the cervical spine can compress the spinal cord and cause this symptom. These changes may include herniated discs, bone spurs, and loss of disc height, all contributing to nerve irritation and compression.
Radiation Myelopathy: Damage to the spinal cord from radiation therapy, often used to treat cancers in the neck and chest areas, can lead to Lhermitte’s sign. This type of injury typically occurs months or years after treatment.
Vitamin B12 Deficiency: This can cause damage to the spinal cord, leading to similar symptoms. Vitamin B12 is essential for maintaining healthy nerve cells, and its deficiency can result in neurological symptoms due to impaired myelin production.
Diagnosis of Lhermitte’s Sign
Clinical Evaluation: A neurologist typically diagnoses Lhermitte’s sign based on the patient’s history and a physical examination. The sensation’s pattern and triggers are key diagnostic clues. The doctor will also review any other MS symptoms the patient may be experiencing, such as vision problems, muscle weakness, or coordination issues.
MRI: Magnetic Resonance Imaging of the cervical spine may be used to detect lesions or other abnormalities in the spinal cord, confirming the underlying cause. MRI can show the presence of demyelinating plaques typical of MS, as well as other structural issues such as cervical spondylosis.
Managing Lhermitte’s Sign
Addressing Underlying Cause: Treatment depends on the underlying condition. For MS, disease-modifying therapies (DMTs) may be used to manage overall disease activity and progression. These therapies aim to reduce the frequency and severity of relapses and slow the progression of disability.
Symptom Management: Medications like gabapentin or pregabalin may be prescribed to manage the neuropathic pain associated with Lhermitte’s sign. These drugs work by stabilizing nerve activity and reducing abnormal nerve signals.
Physical Therapy: Strengthening and stretching exercises may help reduce symptoms by improving neck flexibility and reducing nerve irritation. Physical therapists can develop a tailored exercise program to enhance overall mobility and strength, which can help mitigate the impact of Lhermitte’s sign.
Lifestyle Adjustments: Avoiding triggers such as sudden neck movements and practicing good posture can help manage symptoms. Using supportive devices like a soft cervical collar can also limit neck movements that trigger the sensation.
Prognosis
The presence of Lhermitte’s sign itself is not necessarily indicative of disease progression but is a symptom that reflects underlying spinal cord pathology. Effective management of the underlying condition often helps in alleviating the symptom. Regular monitoring and adjustments in treatment can help manage the overall impact of MS and improve the patient's quality of life.
Understanding and managing Lhermitte’s sign is crucial for individuals with MS or other related conditions. While it can be alarming, proper diagnosis and treatment can significantly improve quality of life.
By understanding Lhermitte’s sign and its management, patients can better navigate their symptoms and maintain their well-being. Always consult with your healthcare provider for personalized advice and treatment options.
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This is so true! The sensation is sudden and very painful. Thanks for sharing!
Thanks for the info. This is a very annoying symptom I experience sometimes. It's helpful to know more about it and how to manage it.
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