Many individuals with Multiple Sclerosis encounter issues with tremors at some point in their disease. Although it may seem like an uncommon symptom, tremor is a quite common symptom. Tremors can occur when someone is sitting, standing or when they are doing something with their hands. Severity ranges from almost unnoticeable to severe and interfering with daily tasks.
By definition, tremors are involuntary muscle contractions that make a body part move back and forth in a rhythmic motion. The most affected body part are the hands, but the midsection, vocal cords, head and legs can be affected as well. There are several different types of tremors in MS; intention, postural and nystagmus.
- Intention Tremors: In this type of tremor, your hand is affected. When you reach for an object, and your hand gets closer and requires more precision, your tremor worsens. This is the most common form of tremor.
- Postural Tremor: This is a tremor that occurs when sitting or standing and your body is attempting to resist the pull of gravity. Usually the tremor lessens or goes away when laying down.
- Nystagmus Tremor: This is a tremor where ones eyes appear to move back and forth rapidly (I mentioned this one in my previous post about vision issues).
Something that should also be mentioned is that tremors shouldn’t happen when laying down either. When you’re laying down, your muscles are relaxed and therefore your tremor shouldn’t be noticeable. If there is some shaking present, it might be something else going on.
Causes of Tremors
Lesions in several parts of the brain, the cerebellum and thalamus, are the cause of tremors. The cerebellum is the part of the brain that controls balance and coordination as well as helps to make the movements of the eyes, mouth and limbs smooth and fluid. The thalamus controls the motor systems of the body. Due to the areas of damage, individuals that have tremors may have trouble with speaking or swallowing as well.
Tremors are one of the harder symptoms to treat. There are many medications that are currently being used to treat tremors, but none that consistently provide relief. The medications available are:
- anticonvulsive medication Mysoline (primidone);
- diuretic Diamox (acetazolamide); and
- anti-anxiety drugs Buspar (buspirone) and Klonopin® (clonazepam).
- anti-tuberculosis agent, isoniazid (INH);
- antihistimines Atarax and Vistaril (hydroxyzine);
- beta-blocker Inderal (propranolol)
A treatment that is on the horizon is Deep Brain Stimulation. This has been shown to be effective for tremors in Parkinson’s Disease, and is now being investigated for tremor management in individuals with MS.
Utilizing exercise can also be a treatment. Working with a physical therapist or occupational therapist to prescribe the best movements and exercises is your best option here, but the goal of the exercises would be balance and coordination. Within the occupational therapy category, using assistive devices like weights, immobilization or braces can be treatments as well.
Tremors can make us embarrassed and want to hide, it’s actually a visible symptom! But we really should be doing the exact opposite. Discussing symptoms with health care professionals is one of the best things we can be doing, at all times!