Tremors are uncontrollable, repetitive movements that affect one or more parts of the body and are a common motor symptom of multiple sclerosis (MS). Around 25 percent to 58 percent of people with MS experience tremors.
If severe tremors limit your day-to-day activities, don’t lose hope. Although there isn’t a cure for MS tremors yet, there are treatment options to help manage this symptom.
There are more than 20 types of tremors, which are further subtyped by their origin point, trigger, and symptoms or appearance. “Gross” describes larger tremor movements and “fine” describes tremors with smaller movements.
Each form of tremor can be classified as either rest tremors or action tremors. MS-related tremors are usually action tremors, specifically a type known as cerebellar tremors.
Action tremors occur when a person makes (or tries to make) their body move, such as reaching for a glass of water. These tremors improve when the body is at rest, or relaxed, and they worsen when the body is active.
Intention tremors occur when a person makes a purposeful body movement — for example, if you touch a finger to the tip of your nose. Intention tremors tend to worsen as the person gets closer to their target (in this case, when your finger gets closer to the tip of your nose). These tremors can be debilitating for people with MS.
Postural tremors occur when you are in a position supporting your body against the forces of gravity — for example, propping yourself up on your elbow while sitting on an armchair. Postural tremors are the most frequently occurring MS tremor.
Rest tremors are rare in people with MS. Rest tremors, as the name suggests, worsen when your body part is at rest and improve when that body part is moving. Rest tremors are more common in people with Parkinson’s disease but can occur in those with MS.
Everyone, even people without a health condition, has an occasional tremor. These are called physiologic tremors. They are barely noticeable for most people and are usually not disabling.
MS affects nerve pathways in certain parts of the central nervous system (CNS), which is made up of the spinal cord and the brain. MS tremors are likely caused by inflammation, lesions, and myelin damage in the CNS. Specifically, lesions in the cerebellum, basal ganglia, and thalamus may lead to tremors. These parts of the CNS control balance, coordination, fine motor function (movement), and posture.
MS-related tremors tend to be worse during flares (relapses) but may also be present when MS is in remission.
Tremors can also be a side effect of medications. Several antidepressants are known to cause tremors in some people. The same goes for some stimulants — even caffeine can cause or make tremors worse.
MS tremors usually affect the limbs (most often, the hands and arms), but the legs and other body parts can be involved. “I’ve been having foot and ankle tremors — just uncontrollable shaking!” wrote one member. “It usually starts with one foot and goes to the other, but it happens in just one sometimes or sometimes both. It’s worse at night.” MS tremors can also affect muscles that control the mouth, leading to speech difficulties (dysarthria) and swallowing problems (dysphagia), along with tremors.
MS tremors can be frustrating and significantly limit one’s ability to do normal daily activities. The near-constant limb movement can be energy-intensive and also disrupt sleep, both of which can make fatigue worse. “This hurts and makes my whole leg muscles tired and achy,” said one member about the tremors in their legs. “This happens at night and also in the day. So tiring.”
Tremors can make it increasingly difficult to maintain a job or carry out everyday activities such as writing, brushing one’s teeth, drinking liquids without spilling, or getting dressed. Depending on tremor severity, it can put significant strain on caretakers and family members. It can also be socially isolating, contributing to mental health issues like anxiety and depression. MS tremors can have a significant impact on one’s quality of life.
If you experience tremors that cause you distress or disrupt your day-to-day life, talk to your primary care doctor or see a neurologist who specializes in movement disorders.
Like MS, there is no one-size-fits-all treatment for MS tremors. These tremors can be challenging to treat. However, several treatments can make MS tremors less disabling and more manageable. Treatments depend on the type of tremor, the part of the body affected, and the area of the CNS affected by MS lesions.
For some, one medication controls their tremor effectively. “When my legs get out of control — for hours! — I routinely take baclofen,” shared a MyMSTeam member. For others, tremor management requires a combination of drugs in addition to other types of therapy. What’s effective will vary between individuals.
Some oral medications sometimes used to treat tremors include:
Research into the effectiveness of cannabis to manage MS symptoms, including tremors, has been underway for the past decade or so. Limited data from a few small studies suggest that cannabis may help some people control their tremors. That said, more clinical trials are needed to determine if and how medical marijuana might provide relief for MS tremors.
If you have MS tremors, your health care provider may recommend physical therapy and occupational therapy to manage them. Physical therapy or occupational therapy may help you find simple coping strategies, such as:
Assistive devices and other accommodations, strategies, and complementary therapies can make your life with a tremor less difficult. Talk to your MS treatment team if you think this strategy might be helpful for you.
Neurosurgical treatments such as deep brain stimulation (DBS) and thalamotomy are sometimes used to treat more severe tremors.
DBS or thalamic stimulation involves surgically implanting an electrode in the brain that carries tiny electric shocks. The device can be inserted into one of the parts of the brain areas responsible for body movement. The electrode is powered by a battery placed under your skin. Targeting these deeper brain structures, DBS may help restore finer control of movements and reduce tremors.
Thalamotomy is a procedure that involves destroying a part of the thalamus that has been damaged by MS. This neurosurgery is performed using radiation, focused ultrasound, or a small probe.
Although the idea of brain surgery may seem risky, technology has advanced so that these surgical treatment options are done more safely than ever in a minimally invasive fashion. Surgery can significantly improve MS tremors for most people, offering long-term relief for many.
All medical interventions pose some risk of side effects or adverse reactions. Be sure to get qualified medical advice and work in a partnership with your health care provider to identify the combination of therapies that work best and are safest for your MS tremors.
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