A to Z of MS Tremor
About one third of people with MS may have tremor. For some people it can be one of the most disabling symptoms of MS as many daily activities, such as writing, eating, dressing and personal hygiene, become difficult to perform.
What is tremor?
Tremor is involuntary, uncontrolled movements. In MS, the type of tremor that is most frequently experienced is intention tremor, a tremor that worsens as the individual reaches for an object. This can be seen during the finger to nose test when the person is asked to lift their arm out to the side and then to bend their elbow and touch their nose with their index finger. Intention tremor will make the hand and arm shake more as the finger approaches the nose
Some people may experience postural tremor, which occurs when a person is maintaining a posture against gravity, such as sitting up.
The cause of tremor in MS?
The exact mechanism of tremor is unknown but is thought to be due to lesions in the cerebellum, the area of the brain responsible for coordinating movement and smooth muscle activity. Stress and anxiety can make tremor worse.
Treatment for tremor
Drug therapy has limited benefits. Beta-blockers may have some effect. Botulinum toxin has been used with some success to treat intrusive head tremor in people with MS.
Physiotherapy treatment can also show limited improvement.
Surgery may be used in severe cases of tremor.
Deep brain stimulation or thalamic stimulation, which has been used successfully in treatment of Parkinson's Disease, may also offer a new approach. A thin wire is surgically implanted into the brain with a battery-operated pulse generator implanted near the collarbone that sends continuous electrical pulses to the brain blocking brain signals.
Living with tremor
Adaptation is a key element to coping with tremor and an occupational therapist may be able to offer advice. Fatigue, common in MS, makes tremor worse and so planning the day's activities appropriately, using aids or tools and finding ways of doing daily activities that don't aggravate tremor are important. For instance, stabilising the head against a headrest may reduce head tremor and make activities such as watching the television easier. Holding the wrist of the active hand with the other hand may help with functions such as combing or brushing hair.
The use of wrist weights has been of limited benefit in dampening tremor. They can be helpful if worn during eating in cases of mild/moderate tremor but prolonged use should be avoided as it has been shown to increase the tremor after the weights have been removed.