Tremor 

What is a tremor?

A tremor is a type of trembling or shaking which may affect your limbs, trunk, head or even your voice and speech.

Are there different types of tremors?

There are several types of tremors:

• Intention tremor – There is no shaking when a person is at rest.  This type of tremor occurs when reaching for something, grasping an object or when you move your hand or foot with purpose.  The shaking may increase as you get closer to your target (for example, reaching for a cup).  This is the most common type of tremor for people with MS.
• Postural tremor – Does not occur while lying down, but rather shaking occurs while sitting or standing.
• Resting tremor – Tremors are greatest when the body is at rest.  This is more common in Parkinson’s disease than in MS.
• Nystagmus – Shaking or jumping movement of the eye.

What causes tremors?

Tremors occur because there are damaged areas along the nerve pathways that control coordination of movement.  People with MS tremors may also have difficulty with speaking or swallowing because these activities also require coordination of movement.

How do you treat tremors?

Tremors are very difficult to treat effectively.
 
Several medications are used with varying success. 
• Anti-anxiety drugs-Buspar (buspirone) and Klonopin (clonazepam)
• Antihistamines-Atarax (hydroxyzine)
• Beta-blocker-Inderal (propranolol)
• Anti-convulsive-Mysoline (primidone)    

Occupational therapy can assist with adaptations to household items.  For example, adding weights to items such as pens, eating utensils, brushes, canes or walkers can increase control.  Arm and hand braces may also work well for tasks like eating or writing.

It may be possible to “overpower the tremor” by adding extra weight to a limb (ankle or wrist).

Deep Brain Stimulation has been used in the past to manage tremors in Parkinson’s disease. This requires surgically implanting electrodes into various areas of the brain.  This type of treatment is still considered experimental in patients with MS.