4 Strategies for Managing MS Tremors

Signs of Tremors in MS

Some of the more common signs of tremors in MS include:

• Shaking
• Jerking
• Trembling
• Twitching

While most MS tremors occur in the hands, they can also affect a person’s arms, head, face, trunk, and legs. “It is a severe problem and makes it difficult to use your hands effectively, walk smoothly, or even sit in a chair,” says Gary Belt, M.D., a board-certified neurologist at the Comprehensive Stroke Center in Summit, New Jersey.

“A tremor can also affect the voice, resulting in a tremulous, wavering voice with difficulty modulating the pitch and volume of speech,” Belt adds.

Typically, a tremor is obvious to others and very difficult to control despite a person’s effort and concentration, says Belt, noting that MS tremors are not present during sleep.

Types of Tremors

According to the National Multiple Sclerosis Society (NMSS), a tremor is classified based on when and how it occurs. Commonly, tremors may be thought of as action or resting tremors. It’s also possible to experience more than one type of tremor.

Action (or Kinetic) Tremors

Action tremors include two types: intention tremors and postural tremors.

For people with MS, an intention tremor is the most common. This type of tremor tends to become intense during physical movement. For example, an intention tremor may occur when reaching for something or holding an object, Belt says.

A postural tremor occurs when your muscles try to hold parts of your body still against gravity, like when holding your arm out straight in front of you.

Resting Tremor

There’s also what’s known as a resting tremor. As the name suggests, the tremor occurs when muscles are at rest.

For example, a resting tremor of the hands may happen when a person has their hands placed on their lap, or walking with their hands by their sides without really paying attention to what their hands are doing, says Sharon Stoll, D.O., a board-certified neurologist and assistant professor in the department of neurology at Yale School of Medicine in North Haven, Connecticut. “This type of tremor is more classic for Parkinson's disease, or Parkinsonian plus syndrome, and not multiple sclerosis,” she notes. In MS it may be rare.

Tremor vs. Ataxia

People with MS can also develop ataxia, Stoll says. Ataxia means “without coordination,” and it is a different movement disorder that can lead to a lack of coordination and balance. While symptoms are similar, ataxia is different from a tremor.

Ataxia is an uncontrolled movement that may be more jerky and exaggerated than tremors, which are more rhythmic. “With ataxia, if I ask someone to touch their nose, they can't control where their hand is going, whereas with intention tremors, they can still get there, but the hand is bouncing all over the place,” Stoll says.

Causes of Tremors

According to Belt, tremors are not necessarily associated with a particular type or phase of MS. Rather, whether you experience tremors seems to depend on what part of the central nervous system has been injured by demyelination (damage to the myelin, the protective coating of nerves).

The cause of tremors in MS can be traced to demyelination of the nerves from the cerebellum, the part of the brain that controls smooth movements and coordination, Belt says. Demyelination of other parts of the nervous system involved in controlling movement, such as the thalamus and basal ganglia, may also lead to tremors.

How to Manage MS Tremors

Tremors can make certain activities like eating and dressing more challenging. And for some people who feel embarrassed by their tremors, hiding this symptom can lead to isolation and loneliness. Managing tremors as best you can may help ease these difficulties.

Although MS tremors are difficult to treat, experts are hopeful that some medical interventions, lifestyle modifications, and routines may help people manage their tremors to make life easier.

Medication

No medication is specifically designated to treat tremors in MS. However, the NMSS lists some medications as options a doctor may prescribe to help manage the symptom, including:

• Clonazepam, an anti-anxiety medication
• Propranolol, a beta blocker
• Primidone, an anti-seizure drug
• Gabapentin, an anti-seizure and nerve pain medication
• Trihexyphenidyl, a muscle relaxant
• Topiramate, an anti-seizure medication

Tremors can sometimes be caused by spasticity, meaning that the muscles are extremely tight. In that situation, your doctor may treat it with onabotulinumtoxinA, or Botox, says Stoll, because it helps loosen the muscles and relax them. Baclofen, a muscle relaxant, is also often recommended for tremors, Stoll says.

Stress Management

Stress management strategies may help reduce the intensity and frequency of MS-related tremors, according to the NMSS. That’s because tremors can worsen during stressful situations. You can talk to your doctor or a mental health professional about relaxation methods such as deep breathing and progressive muscle relaxation, a technique that involves clenching and releasing different muscles to help let go of tension.

Occupational and Physical Therapy

If tremors are interfering with your daily activities, consider working with an occupational therapist to learn about assistive devices that may help you adapt. A physical therapist may also be a good resource to you if tremors have increased your risk of falling or made it difficult to get around.

Occupational and physical therapy may not stop the tremors, but they can make life with MS tremors a bit easier. “Rehab measures like physical, occupational, and speech therapy have limited benefit, but they can be tried to help to establish adaptations to control the tremor,” Belt says.

Surgery

In rare and severe cases, doctors may recommend surgery like deep brain stimulation, or DBS. According to Belt, during DBS, a stimulating electrode is implanted in the thalamus, another region of the brain that’s involved in movement. Then, a constant electrical pulse is used to “turn off” the part of the brain that is contributing to the tremors.

Another surgical technique is a thalamotomy. During this procedure, a doctor surgically destroys part of the thalamus. This is a much more destructive procedure than DBS, Belt notes.

If tremors and shaking are affecting your overall well‑being, talk with your doctor about the best way to manage or adapt to this symptom. Your doctor may be able to recommend approaches like medication, lifestyle modifications, or therapy to help you cope.

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