From the Research
Lhermitte syndrome is a neurological condition that requires immediate medical evaluation to address the underlying cause, with treatment focusing on the cause rather than the symptom itself, as evidenced by the most recent systematic review 1.
Causes and Symptoms
Lhermitte syndrome is characterized by a sudden, brief, electric-like sensation that runs down the spine and into the limbs when the neck is flexed forward. This symptom, often described as a shock-like sensation, is caused by irritation or damage to the posterior columns of the cervical spinal cord. The most common causes include multiple sclerosis, cervical spondylosis, radiation myelopathy, vitamin B12 deficiency, and trauma to the spinal cord.
Treatment
Treatment focuses on addressing the underlying cause rather than the symptom itself. For multiple sclerosis-related Lhermitte's, disease-modifying therapies may help. Anti-seizure medications like carbamazepine (200-400 mg twice daily) or gabapentin (300-1200 mg three times daily) can provide symptomatic relief, as suggested by observational data 1. Physical therapy and avoiding activities that trigger the sensation are also recommended. In cases related to vitamin deficiency, supplementation (such as vitamin B12 1000 mcg daily) may resolve symptoms, as reported in a case study 2.
Key Considerations
- The most recent systematic review highlights the lack of randomized studies to support the use of symptomatic therapies to treat Lhermitte's phenomenon, emphasizing the need for further controlled studies 1.
- Medication-induced Lhermitte's phenomenon, particularly with platinum-based chemotherapy agents, is a common theme in the literature, with symptoms typically resolving with cessation of the causative agent 1.
- Patients should be aware that while the sensation is uncomfortable and startling, it's typically not dangerous by itself but serves as an important clinical indicator of underlying neurological issues that require medical evaluation.
Management Approach
- A thorough medical evaluation is essential to determine the underlying cause of Lhermitte syndrome.
- Treatment should be tailored to the underlying cause, with a focus on addressing the root cause rather than just the symptom.
- Symptomatic relief may be achieved with anti-seizure medications, physical therapy, and avoiding trigger activities, as supported by observational data 1.