Tremor

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Tremor, or uncontrollable shaking, is a common symptom of MS and can occur in various parts of the body. Severe, disabling tremor affects about 30% of people with MS.

There are different types of tremor that can affect you, each with distinct features and characteristics. The major types of tremor include action tremors, which include intention tremor and postural tremor, and resting tremors. Additionally, nystagmus is a type of tremor that affects the eyes.

Tremor is caused by lesions in the brain, specifically in the cerebellum, and along the nerve pathways involved in coordination of motor movements. Since nerves involved in coordinating muscle movements often serve multiple muscle groups associated with different functions, people with MS who have tremors may also develop speech problems (dysarthria) or problems swallowing (dysphagia).

 

Types of tremors in MS

Action tremors

  • Intention tremor:
    • Most common and generally most disabling form of tremor in MS
    • Typically occurs during physical movement and absent during rest
    • Starts to develop and becomes more pronounced as person attempts to reach for object or move hand or foot to specific location
  • Postural tremor: Typically occurs when limb or whole body is being supported against gravity (eg, during sitting or standing, but not while lying down)

Resting  tremors

  • Typically occurs when the affected body part is at rest and decreases with movement
  • More typical of Parkinson’s disease than MS

Nystagmus

  • Characterized by jumpy eye movements

 

What are treatment options for tremors?

Tremors are among the most difficult MS symptoms to manage or treat. Treatment options include exercises for balance and coordination, mechanical approaches, such as wearing weights or stabilizing braces, and medication. While none of these approaches will eliminate tremors completely, the goal is to combine different approaches to reduce tremors and improve function.
 

Management options for tremors

Exercises for balance and coordination

  • Patterning
  • Vestibular stimulation
  • Swiss ball
  • Computerized balance stimulation

Mechanical approaches

  • Weighting
  • Immobilization
  • Stabilizing braces

Medications

  • Klonopin (clonazepam): benzodiazepine
  • Inderal (propranolol): beta-blocker
  • Buspar (buspirone): anti-anxiety
  • Zofran (ondansetron): serotonin receptor blocker, anti-nausea
  • Mysoline (primidone): anti-seizure
  • Diamox (acetazolamide): anti-seizure
  • Lioresal (baclofen): muscle relaxant
  • Isoniazid: tuberculosis medication

 

While no specific exercises for tremor exist, exercises to improve balance and coordination may be useful. A technique called patterning, or repeating patterns of basic movements, can be used to improve coordination by repeatedly using nerve circuits involved in those movements. Vestibular stimulation is a technique that uses rocking, swinging, or spinning movements to challenge and improve function of balance centers in the brain. Other exercise techniques include use of a Swiss Ball (used for performing balance exercises) and computerized balance stimulation. In computerized balance stimulation, a person stands on a platform in front of a computer monitor and follows instruction to complete specific movements, then receives feedback on those movements as a way to practice balance.

Mechanical (physiologic) approaches to controlling tremor include immobilization (using a rigid brace over a joint to restrict movement), weighting (attaching a weight to part of the body affected by tremor to gain control over random movements), and stabilization with braces.

A variety of medications may be used to decrease tremor. These include drugs that have a sedative or calming effect, such as the antihistamine hydroxyzine or the benzodiazepine clonazepam, and other medications that block nerve signaling.

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