Tremor as a Symptom of Multiple Sclerosis

Table of ContentsView AllTable of ContentsSigns and SymptomsCausesTreatmentCoping

Table of ContentsView All

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Table of Contents

Signs and Symptoms

Causes

Treatment

Coping

Tremor—shaking that you can’t control—is a common symptom ofmultiple sclerosis(MS) that usually develops after at least five years of having the disease, though this isn’t a hard-and-fast rule.Tremors can occur when you’re trying to do something with your hands, whether you’re standing or sitting, and their severity can range from being barely noticeable to significantly interfering with your daily tasks.

Verywell / JR Bee

Tremors are involuntary muscular contractions that result in a rhythmic, back-and-forth movement of a specific body part. While your hands are most often affected, tremor also can affect your legs, vocal cords, head, and trunk. It can come and go or get progressively worse with time.

There are a number of different kinds of tremors, but the two main types in MS include:

If you have a tremor in your jaw, lip, or tongue,this may affect your ability to swallow (dysphagia) or to speak clearly (dysarthria).

For the majority of people, tremor is mostly annoying, may make everyday tasks more difficult, and can be embarrassing. However, a small percentage of people may experience tremor so severe that it becomes impossible to perform necessary tasks like eating, drinking, or getting dressed.

It’s important to note that you shouldn’t experience either intention tremor or postural tremor when you’re asleep or even just lying down and your muscles are relaxed. If you have a tremor while you’re resting, this may be the result of something else, since resting tremors are rare in MS, so be sure to talk to your healthcare provider about it.

The Types of Tremors

Tremor can also be the result of demyelination in the thalamus, the part of your brain that controls the motor systems in your body, and the basal ganglia, which are located on either side of the thalamus in your brain and help control movement.

Tremor can occur as a relapse symptom and disappear on its own or after a course ofcorticosteroids, though it’s also common for a residual tremor to remain.

The severity of tremor is not linked to how long you’ve had MS.

Around 45 percent to 47 percent of MS patients experience tremors, with 5.5 percent to 5.9 percent reporting severe tremor, according to a 2015 study.

Because there are no official treatment guidelines for MS-related tremor, it can be a tricky symptom to treat. It’s often a trial-and-error process to see which approaches work best for you, and as your symptoms change, you may need to explore different treatment options.

Keep in mind that even though treatment can reduce your tremors, it most likely won’t eliminate them completely.

Medications

Medications your healthcare provider may prescribe include:

An Overview of Multiple Sclerosis Treatments

Effectiveness

A 2016 study of 567 participants with MS tremors found that 47 percent used medication to treat them. The majority of those using medication said they had moderate (54 percent) or severe (51 percent) tremor, while the others characterized their tremors as mild (37 percent) or completely disabling (35 percent).

A 2018 review of studies on treatments for upper-limb tremors in patients with MS showed that Nydrazid (isoniazid) has been the most-studied pharmacologic intervention to treat tremor and helped relieve it in 60 percent to 80 percent of patients. However, the studies were all quite small and conducted in the 1980s.

The review also noted that a 2014 study of the effect of disease-modifying therapies on tremor established that patients taking Tysabri (natalizumab) were more likely to report improvement in their tremor than those on other forms of disease-modifying drugs.

Additionally, the researchers found that the most commonly noted side effects across the board for all the medication options for tremor were fatigue and weakness.

Choosing the Best Disease-Modifying Drug for You

Therapies

For many MS patients, a rehabilitative plan that involves one or more forms of therapy can reduce tremor.

Occupational Therapy

Anoccupational therapistcan help you find and learn to use special equipment that assists you with daily activities, such as braces for affected joints, weights for affected areas or for items you need to use, and other aids for writing, cooking, eating, and getting dressed.

Occupational therapy can also help you learn strategies for coping with tremor and maintaining good posture and alignment when you’re carrying out your activities of living.

Physical Therapy

If your tremors affect your balance, coordination, and ability to walk, you may especially benefit fromphysical therapy. A physical therapist can give you exercises that strengthen your core, improve your balance, and keep you active and flexible, as well as help you develop good posture and alignment, all of which can reduce your tremor.

Speech Therapy

Surgery

If your tremor is severe and other treatment options haven’t worked for you, surgery may be an option. There are two types of surgeries that can be used to treat MS tremors.

Deep Brain Stimulation (DBS)

This method, also known as thalamic stimulation, has been the surgery of choice for MS-related tremors for the last couple of decades. In DBS, the surgeon places battery-operated electrodes in your thalamus that deliver small electric currents to stimulate certain areas, lessening your tremors.

Stereotactic Thalamotomy

In stereotactic thalamotomy, also known as lesion surgery, a specific area in your thalamus is destroyed using radiofrequency or focused ultrasound. These precise locations are located before the surgery on amagnetic resonance imaging (MRI)scan or acomputerized tomography (CT)scan. Essentially, this destruction prevents your brain from transmitting signals that cause your tremors.

Thalamotomy is permanent and can cause side effects like weakness, fatigue, and seizures, though these may go away with time.

A 2019 reviewof studies on DBS and thalamotomy in patients with tremor, some of which included MS-related tremor, concluded that both types of surgery are equally effective in successfully reducing tremor and improving quality of life. The researchers also did a subgroup analysis that indicated that thalamotomy that’s performed with focused ultrasound may improve quality of life even more than other types of thalamotomy or DBS.

Botulinum Toxin

Only two small studies, one from 1997 and another from 2012, have been done so far on the effects of botulinum toxin injections on MS tremor.

The 2012 study utilizedelectromyography (EMG)guidance to inject the 23 participants with either Botox (onabotulinumtoxinA) or placebo in targeted areas of one or both arms where their tremors appeared. After 12 weeks, the participants received the reverse treatment.

The researchers found that Botox significantly improved hand tremors and coordination difficulties, calledataxia, which in turn decreased the amount of disability the tremors caused. And though around 42 percent of the participants developed mild to moderate weakness after the Botox injection, this went away completely within two weeks.

Botulinum toxin injections may be an option to decrease your tremors, especially if you can’t take medications, you aren’t experiencing enough relief with other treatments, or you’re not a candidate for surgery. Talk to your healthcare provider about whether or not this is a viable choice for you.

You can take practical steps to keep yourself healthy, which can help you cope with your tremors and other MS symptoms more effectively. Consider trying the following.

Tremor can be one of the more challenging symptoms in MS, and, like every one of them, how tremor affects you is very personal. If you find yourself dealing with it, try to be patient and keep communication open as you and your healthcare provider figure out what treatment options work best.

Causes of Tremors

17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NIH National institute of Neurological Disorders and Stroke.Multiple sclerosis information page.National Multiple Sclerosis Society.Tremor.Multiple Sclerosis Association of America.Tremor.Boonstra F, Florescu G, Evans A, et al.Tremor in multiple sclerosis is associated with cerebello-thalamic pathology.J Neural Transm (Vienna). 2017;124(12):1509-1514. doi:10.1007/s00702-017-1798-4Cleveland Clinic.Essential Tremor.Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR.Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey.BMJ Open. 2015;5(1):e006714. doi:10.1136/bmjopen-2014-006714Cleveland Clinic.Drug treatments for essential tremor.Meador W, Salter AR, Rinker JR.Symptomatic management of multiple sclerosis-associated tremor among participants in the NARCOMS registry.Int J MS Care. 2016;18(3):147-53. doi:10.7224/1537-2073.2015-008University of California San Fransisco.Symptom management.Mccreary JK, Rogers JA, Forwell SJ.Upper limb intention tremor in multiple sclerosis.International Journal of MS Care. 2018;20(5):211-223. doi:10.7224/1537-2073.2017-024.Johns Hopkins Medicine.Multiple sclerosis rehabilitation.Mandat T, Koziara H, Tutaj M, Rola R, Bonicki W, Nauman P.Thalamic deep brain stimulation for tremor among multiple sclerosis patients.Neurologia i Neurochirurgia Polska. 2010;44(6):542-545. doi:10.1016/s0028-3843(14)60150-xKincses ZT, Szabó N, Valálik I, et al.Target identification for stereotactic thalamotomy using diffusion tractography.PLoS ONE. 2012;7(1):e29969. doi:10.1371/journal.pone.0029969Alusi SH, Aziz TZ, Glickman S, Jahanshahi M, Stein JF, Bain PG.Stereotactical lesion surgery for the treatment of tremor in multiple sclerosis. A prospective case-controlled study.Brain.Altinel Y, Alkhalfan F, Qiao N, Velimirovic M.Outcomes in lesion surgery versus deep brain stimulation in patients with tremor: A systematic review and meta-analysis.World Neurosurg. 2019;123:443-452.e8. doi:10.1016/j.wneu.2018.11.175Mittal SO, Lenka A, Jankovic J.Botulinum toxin for the treatment of tremor.Parkinsonism Relat Disord. 2019. doi:10.1016/j.parkreldis.2019.01.023Johns Hopkins Medicine.Essential tremor disorder.Additional ReadingAltinel Y, Alkhalfan F, Qiao N, Velimirovic M.Outcomes in Lesion Surgery versus Deep Brain Stimulation in Patients with Tremor: A Systematic Review and Meta-Analysis.World Neurosurgery. 2019;123:443–452.e8. doi:doi.org/10.1016/j.wneu.2018.11.175.McCreary JK, Rogers JA, Forwell SJ.Upper Limb Intention Tremor in Multiple Sclerosis: An Evidence-Based Review of Assessment and Treatment.International Journal of MS Care. 2018;20(5):211–223. doi:10.7224/1537-2073.2017-024.Meador W, Salter AR, Rinker JR.Symptomatic Management of Multiple Sclerosis-Associated Tremor Among Participants in the NARCOMS Registry.International Journal of MS Care. 2016;18(3):147–153. doi:10.7224/1537-2073.2015-008.Mittal SO, Lenka A, Jankovic J.Botulinum Toxin for the Treatment of Tremor. Parkinsonism & Related Disorders. Published January 25, 2019. doi:10.1016/j.parkreldis.2019.01.023.National Multiple Sclerosis Society.Tremor. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Tremor.Rinker JR II, Salter AR, Walker H, Amara A, Meador W, Cutter GR.Prevalence and Characteristics of Tremor in the NARCOMS Multiple Sclerosis Registry: A Cross-Sectional Survey.BMJ Open. 2015 Jan 8;5(1):e006714. doi:10.1136%2Fbmjopen-2014-006714.

17 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NIH National institute of Neurological Disorders and Stroke.Multiple sclerosis information page.National Multiple Sclerosis Society.Tremor.Multiple Sclerosis Association of America.Tremor.Boonstra F, Florescu G, Evans A, et al.Tremor in multiple sclerosis is associated with cerebello-thalamic pathology.J Neural Transm (Vienna). 2017;124(12):1509-1514. doi:10.1007/s00702-017-1798-4Cleveland Clinic.Essential Tremor.Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR.Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey.BMJ Open. 2015;5(1):e006714. doi:10.1136/bmjopen-2014-006714Cleveland Clinic.Drug treatments for essential tremor.Meador W, Salter AR, Rinker JR.Symptomatic management of multiple sclerosis-associated tremor among participants in the NARCOMS registry.Int J MS Care. 2016;18(3):147-53. doi:10.7224/1537-2073.2015-008University of California San Fransisco.Symptom management.Mccreary JK, Rogers JA, Forwell SJ.Upper limb intention tremor in multiple sclerosis.International Journal of MS Care. 2018;20(5):211-223. doi:10.7224/1537-2073.2017-024.Johns Hopkins Medicine.Multiple sclerosis rehabilitation.Mandat T, Koziara H, Tutaj M, Rola R, Bonicki W, Nauman P.Thalamic deep brain stimulation for tremor among multiple sclerosis patients.Neurologia i Neurochirurgia Polska. 2010;44(6):542-545. doi:10.1016/s0028-3843(14)60150-xKincses ZT, Szabó N, Valálik I, et al.Target identification for stereotactic thalamotomy using diffusion tractography.PLoS ONE. 2012;7(1):e29969. doi:10.1371/journal.pone.0029969Alusi SH, Aziz TZ, Glickman S, Jahanshahi M, Stein JF, Bain PG.Stereotactical lesion surgery for the treatment of tremor in multiple sclerosis. A prospective case-controlled study.Brain.Altinel Y, Alkhalfan F, Qiao N, Velimirovic M.Outcomes in lesion surgery versus deep brain stimulation in patients with tremor: A systematic review and meta-analysis.World Neurosurg. 2019;123:443-452.e8. doi:10.1016/j.wneu.2018.11.175Mittal SO, Lenka A, Jankovic J.Botulinum toxin for the treatment of tremor.Parkinsonism Relat Disord. 2019. doi:10.1016/j.parkreldis.2019.01.023Johns Hopkins Medicine.Essential tremor disorder.Additional ReadingAltinel Y, Alkhalfan F, Qiao N, Velimirovic M.Outcomes in Lesion Surgery versus Deep Brain Stimulation in Patients with Tremor: A Systematic Review and Meta-Analysis.World Neurosurgery. 2019;123:443–452.e8. doi:doi.org/10.1016/j.wneu.2018.11.175.McCreary JK, Rogers JA, Forwell SJ.Upper Limb Intention Tremor in Multiple Sclerosis: An Evidence-Based Review of Assessment and Treatment.International Journal of MS Care. 2018;20(5):211–223. doi:10.7224/1537-2073.2017-024.Meador W, Salter AR, Rinker JR.Symptomatic Management of Multiple Sclerosis-Associated Tremor Among Participants in the NARCOMS Registry.International Journal of MS Care. 2016;18(3):147–153. doi:10.7224/1537-2073.2015-008.Mittal SO, Lenka A, Jankovic J.Botulinum Toxin for the Treatment of Tremor. Parkinsonism & Related Disorders. Published January 25, 2019. doi:10.1016/j.parkreldis.2019.01.023.National Multiple Sclerosis Society.Tremor. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Tremor.Rinker JR II, Salter AR, Walker H, Amara A, Meador W, Cutter GR.Prevalence and Characteristics of Tremor in the NARCOMS Multiple Sclerosis Registry: A Cross-Sectional Survey.BMJ Open. 2015 Jan 8;5(1):e006714. doi:10.1136%2Fbmjopen-2014-006714.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

NIH National institute of Neurological Disorders and Stroke.Multiple sclerosis information page.National Multiple Sclerosis Society.Tremor.Multiple Sclerosis Association of America.Tremor.Boonstra F, Florescu G, Evans A, et al.Tremor in multiple sclerosis is associated with cerebello-thalamic pathology.J Neural Transm (Vienna). 2017;124(12):1509-1514. doi:10.1007/s00702-017-1798-4Cleveland Clinic.Essential Tremor.Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR.Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey.BMJ Open. 2015;5(1):e006714. doi:10.1136/bmjopen-2014-006714Cleveland Clinic.Drug treatments for essential tremor.Meador W, Salter AR, Rinker JR.Symptomatic management of multiple sclerosis-associated tremor among participants in the NARCOMS registry.Int J MS Care. 2016;18(3):147-53. doi:10.7224/1537-2073.2015-008University of California San Fransisco.Symptom management.Mccreary JK, Rogers JA, Forwell SJ.Upper limb intention tremor in multiple sclerosis.International Journal of MS Care. 2018;20(5):211-223. doi:10.7224/1537-2073.2017-024.Johns Hopkins Medicine.Multiple sclerosis rehabilitation.Mandat T, Koziara H, Tutaj M, Rola R, Bonicki W, Nauman P.Thalamic deep brain stimulation for tremor among multiple sclerosis patients.Neurologia i Neurochirurgia Polska. 2010;44(6):542-545. doi:10.1016/s0028-3843(14)60150-xKincses ZT, Szabó N, Valálik I, et al.Target identification for stereotactic thalamotomy using diffusion tractography.PLoS ONE. 2012;7(1):e29969. doi:10.1371/journal.pone.0029969Alusi SH, Aziz TZ, Glickman S, Jahanshahi M, Stein JF, Bain PG.Stereotactical lesion surgery for the treatment of tremor in multiple sclerosis. A prospective case-controlled study.Brain.Altinel Y, Alkhalfan F, Qiao N, Velimirovic M.Outcomes in lesion surgery versus deep brain stimulation in patients with tremor: A systematic review and meta-analysis.World Neurosurg. 2019;123:443-452.e8. doi:10.1016/j.wneu.2018.11.175Mittal SO, Lenka A, Jankovic J.Botulinum toxin for the treatment of tremor.Parkinsonism Relat Disord. 2019. doi:10.1016/j.parkreldis.2019.01.023Johns Hopkins Medicine.Essential tremor disorder.

NIH National institute of Neurological Disorders and Stroke.Multiple sclerosis information page.

National Multiple Sclerosis Society.Tremor.

Multiple Sclerosis Association of America.Tremor.

Boonstra F, Florescu G, Evans A, et al.Tremor in multiple sclerosis is associated with cerebello-thalamic pathology.J Neural Transm (Vienna). 2017;124(12):1509-1514. doi:10.1007/s00702-017-1798-4

Cleveland Clinic.Essential Tremor.

Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR.Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey.BMJ Open. 2015;5(1):e006714. doi:10.1136/bmjopen-2014-006714

Cleveland Clinic.Drug treatments for essential tremor.

Meador W, Salter AR, Rinker JR.Symptomatic management of multiple sclerosis-associated tremor among participants in the NARCOMS registry.Int J MS Care. 2016;18(3):147-53. doi:10.7224/1537-2073.2015-008

University of California San Fransisco.Symptom management.

Mccreary JK, Rogers JA, Forwell SJ.Upper limb intention tremor in multiple sclerosis.International Journal of MS Care. 2018;20(5):211-223. doi:10.7224/1537-2073.2017-024.

Johns Hopkins Medicine.Multiple sclerosis rehabilitation.

Mandat T, Koziara H, Tutaj M, Rola R, Bonicki W, Nauman P.Thalamic deep brain stimulation for tremor among multiple sclerosis patients.Neurologia i Neurochirurgia Polska. 2010;44(6):542-545. doi:10.1016/s0028-3843(14)60150-x

Kincses ZT, Szabó N, Valálik I, et al.Target identification for stereotactic thalamotomy using diffusion tractography.PLoS ONE. 2012;7(1):e29969. doi:10.1371/journal.pone.0029969

Alusi SH, Aziz TZ, Glickman S, Jahanshahi M, Stein JF, Bain PG.Stereotactical lesion surgery for the treatment of tremor in multiple sclerosis. A prospective case-controlled study.Brain.

Altinel Y, Alkhalfan F, Qiao N, Velimirovic M.Outcomes in lesion surgery versus deep brain stimulation in patients with tremor: A systematic review and meta-analysis.World Neurosurg. 2019;123:443-452.e8. doi:10.1016/j.wneu.2018.11.175

Mittal SO, Lenka A, Jankovic J.Botulinum toxin for the treatment of tremor.Parkinsonism Relat Disord. 2019. doi:10.1016/j.parkreldis.2019.01.023

Johns Hopkins Medicine.Essential tremor disorder.

Altinel Y, Alkhalfan F, Qiao N, Velimirovic M.Outcomes in Lesion Surgery versus Deep Brain Stimulation in Patients with Tremor: A Systematic Review and Meta-Analysis.World Neurosurgery. 2019;123:443–452.e8. doi:doi.org/10.1016/j.wneu.2018.11.175.McCreary JK, Rogers JA, Forwell SJ.Upper Limb Intention Tremor in Multiple Sclerosis: An Evidence-Based Review of Assessment and Treatment.International Journal of MS Care. 2018;20(5):211–223. doi:10.7224/1537-2073.2017-024.Meador W, Salter AR, Rinker JR.Symptomatic Management of Multiple Sclerosis-Associated Tremor Among Participants in the NARCOMS Registry.International Journal of MS Care. 2016;18(3):147–153. doi:10.7224/1537-2073.2015-008.Mittal SO, Lenka A, Jankovic J.Botulinum Toxin for the Treatment of Tremor. Parkinsonism & Related Disorders. Published January 25, 2019. doi:10.1016/j.parkreldis.2019.01.023.National Multiple Sclerosis Society.Tremor. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Tremor.Rinker JR II, Salter AR, Walker H, Amara A, Meador W, Cutter GR.Prevalence and Characteristics of Tremor in the NARCOMS Multiple Sclerosis Registry: A Cross-Sectional Survey.BMJ Open. 2015 Jan 8;5(1):e006714. doi:10.1136%2Fbmjopen-2014-006714.

Altinel Y, Alkhalfan F, Qiao N, Velimirovic M.Outcomes in Lesion Surgery versus Deep Brain Stimulation in Patients with Tremor: A Systematic Review and Meta-Analysis.World Neurosurgery. 2019;123:443–452.e8. doi:doi.org/10.1016/j.wneu.2018.11.175.

McCreary JK, Rogers JA, Forwell SJ.Upper Limb Intention Tremor in Multiple Sclerosis: An Evidence-Based Review of Assessment and Treatment.International Journal of MS Care. 2018;20(5):211–223. doi:10.7224/1537-2073.2017-024.

Meador W, Salter AR, Rinker JR.Symptomatic Management of Multiple Sclerosis-Associated Tremor Among Participants in the NARCOMS Registry.International Journal of MS Care. 2016;18(3):147–153. doi:10.7224/1537-2073.2015-008.

Mittal SO, Lenka A, Jankovic J.Botulinum Toxin for the Treatment of Tremor. Parkinsonism & Related Disorders. Published January 25, 2019. doi:10.1016/j.parkreldis.2019.01.023.

National Multiple Sclerosis Society.Tremor. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Tremor.

Rinker JR II, Salter AR, Walker H, Amara A, Meador W, Cutter GR.Prevalence and Characteristics of Tremor in the NARCOMS Multiple Sclerosis Registry: A Cross-Sectional Survey.BMJ Open. 2015 Jan 8;5(1):e006714. doi:10.1136%2Fbmjopen-2014-006714.

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