Tremors are a common symptom of multiple sclerosis (MS). A tremor occurs when a muscle contracts and then relaxes involuntarily, shaking part of the body. MS tremors can significantly affect a person’s ability to speak, eat, drink, or move around.
This article looks at MS tremors, their causes, and types and explores some treatment options to help manage MS tremors symptoms.
Tremors occur when opposing muscle groups repeatedly relax and contract, causing involuntary and rhythmic shaking.
Tremors can affect one or more areas of the body. They may come and go or may be continuous. Tremors often affect the following
- the head
- vocal cords
Tremors develop because of damage along the nerve pathways and areas of the brain responsible for coordinating movements. They are one of the most common symptoms of MS and can become extremely challenging if they impact daily tasks, such as eating or getting dressed.
Action tremors occur during movement. There are several subtypes:
- Kinetic tremor: This type of tremor occurs during any voluntary movement, such as moving the wrists or opening and closing the eyes.
- Intention tremor: Intention tremors are similar to kinetic tremors but become more pronounced when a person tries to move toward a specific target. For example, they may occur as someone reaches for an object and stop when they are resting. The tremor typically worsens as a person gets closer to the target.
- Postural tremor: Postural tremors occur when a person has their body in a position that works against gravity, such as sitting, standing, or holding their arms outstretched. It becomes more pronounced when the whole body or a limb resists gravity and will usually stop when a person is lying down.
- Isometric tremor: These tremors occur when a person contracts their muscles against a stationary object. For example, an isometric tremor could happen if someone held a heavy book.
Resting tremors occur when the muscle is in a relaxed state. This means someone’s hands, legs, or arms may shake even when they are at rest. These tremors affect people with Parkinson’s disease more commonly than people with MS.
MS tremors can be challenging to manage. However, there are ways people can adapt their routines and behaviors to make life easier. These include:
Home and workplace adaptations
Depending on the severity of the tremor, a person may need to make adaptations to their home, workplace, or daily routine to accommodate it.
Where possible, it can help to get support from an occupational therapist. Occupational therapists help people with daily functioning so that they can continue living independently. They may:
- help someone adapt their daily routine to better suit their needs
- help someone adapt their home so that it is more functional and easier to move around
- recommend specialist tools or equipment, such as jar openers, writing aids, or weighted utensils
- show someone how to use voice-activated settings on devices
- show people ways they can move with less difficulty
A physical therapist can help those with a tremor improve their muscle strength, flexibility, and control. This can help with this symptom, to an extent, though it cannot cure it. Regular stretching or muscle exercises may reduce spasms.
Physical therapies can also teach people how to use mobility aids, such as crutches or a wheelchair.
Speech or language therapy
Speech-language therapists treat speech, communication, swallowing, and language disorders. A speech therapist may be able to help a person with MS who experiences:
- slurring or slowing of speech
- difficulty remembering words or reading
- difficulty swallowing
The therapist can develop programs to help people manage their symptoms. They may work with both the individual with MS and their family to optimize the treatment plan.
There are some specific treatments that doctors can prescribe to help with tremors. These include:
Doctors often prescribe disease-modifying medications (DMARDs) to slow the course of MS, but other drugs work specifically to reduce tremors. These include:
- beta-blockers, such as propanolol
- anticonvulsants, such as gabapentin
- isoniazid (Laniazid, Nydrazid), which is a medication that doctors also prescribe to treat tuberculosis
- clonazepam (Klonopin), which is a type of benzodiazepine
However, some of these drugs have side effects and can cause dependence. It is important to talk through the risks and benefits of medications for MS tremors with a doctor.
Botox treatment can help alleviate some tremors. It involves doctors injecting Botulinum toxin, or Botox, to paralyze muscles temporarily. The effect wears off, so a person will require repeat Botox injections to control the tremor.
Some noninvasive procedures can destroy specific parts of the brain that cause tremors. These include magnetic resonance-guided ultrasound (MRgFUS) and stereotactic radiosurgery.
MRgFUS uses ultrasound waves to create heat in specific parts of the brain without damaging the surrounding tissue. Doctors do this while using an MRI machine to guide the focus of the ultrasound.
Stereotactic radiosurgery is similar to MRgFUS but uses radioactive waves to target a specific part of the brain. It is also known as gamma knife surgery.
Deep brain stimulation (DBS)
DBS could be an option for someone with severe MS tremors. This treatment involves a surgeon implanting electrodes in the area of the brain responsible for coordinating some involuntary movements. They implant a battery near the collarbone to power the electrodes, which then deliver electrical pulses to stop the tremors.
There is not much research on DBS and its long-term effects in people with MS. There are also risks to undergoing brain surgery.
MS is an autoimmune disease that occurs when the body’s immune system attacks healthy tissues. In MS, the immune system mistakenly attacks nerves and the protective myelin sheath around them.
MS causes damage to the nerves in the cerebellum, which is the part of the brain that controls balance and coordination, and this is what usually causes tremors. MS can also damage the thalamus and basal ganglia areas of the brain, which are also responsible for movement.
Some people may find they only experience tremors during a relapse if they have relapsing-remitting MS. Others may have some degree of tremor all of the time.
Many individuals with MS experience tremors. A tremor is an involuntary, rhythmic muscle movement that can occur anywhere in the body.
In MS, tremors are typically intentional or postural. Intentional tremors occur when someone tries to move toward a specific target, while postural tremors occur when someone moves against gravity.
Medications or noninvasive surgeries can reduce tremors. People can also make it easier to live with tremors by adapting their daily habits or their home. Occupational, physical, or speech-language therapists may be able to offer support.