MULTIPLE SCLEROSIS (MS) TREMOR

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Multiple Sclerosis (MS) tremor is a symptom commonly experienced by individuals living with multiple sclerosis, a chronic autoimmune condition affecting the central nervous system. This neurological disorder is characterized by the body’s immune system mistakenly attacking the protective covering of nerve fibers, leading to communication problems between the brain and the rest of the body. Among the array of symptoms that MS can manifest, tremors can significantly impact an individual’s quality of life, affecting their ability to perform everyday tasks.

A tremor occurs when a part of the body moves or shakes involuntarily. In individuals with multiple sclerosis (MS), tremors are common and can affect various body parts such as the head, arms, or legs.

Types of tremors

Types of tremors commonly associated with MS include:

1. Intention tremor: This type of tremor occurs when attempting to perform a specific task, such as reaching for an object or moving a hand or foot to a precise location. It is the most common form of tremor in MS and can significantly impact daily activities.
2. Postural tremor: Postural tremors occur when sitting or standing but not when lying down. These tremors are noticeable when maintaining a specific posture but may subside when the affected individual changes positions.
3. Resting tremor: Unlike intention tremors, resting tremors manifest when the body is at rest and decrease with movement. While more commonly associated with Parkinson’s disease, resting tremors can also occur in individuals with MS.
4. Nystagmus: Nystagmus refers to involuntary and rhythmic eye movements, which can appear as jumpy or jerky motions. While not a typical tremor, it is a neurological symptom that can accompany MS.

Tremor and depression

Tremors can also have a significant impact on mental health, potentially leading to feelings of social isolation and depression. Seeking support from a psychologist or counselor can be beneficial in coping with these emotional challenges and developing strategies to manage tremors effectively in social situations.

Causes of Multiple Sclerosis (MS) tremor

Multiple sclerosis (MS) causes tremors primarily due to the damage it inflicts on the protective sheath called myelin, which surrounds the nerves in the brain and spinal cord. This myelin damage disrupts the normal transmission of nerve signals, leading to various neurological symptoms, including tremors.

Tremors associated with MS often result from damage to a specific region of the brain known as the cerebellum. The cerebellum plays a crucial role in coordinating movement, maintaining balance, and ensuring smooth and precise muscle actions during voluntary movements such as reaching, grasping, and speaking.

When myelin damage affects the cerebellum, it interferes with its ability to regulate and coordinate muscle movements effectively. As a result, individuals with MS may experience tremors as their nervous system struggles to control and synchronize muscle activity, leading to involuntary shaking or trembling in different parts of the body.

Prevalence

MS tremor is a common symptom that individuals living with multiple sclerosis experience. Studies suggest that approximately 75% of individuals with MS may experience tremors at some point during the course of their illness.

Symptoms

The primary symptom of Multiple Sclerosis (MS) tremors is involuntary shaking or trembling of one or more body parts. This trembling can occur in the hands, arms, legs, or even the head, and it may worsen with movement or stress. The intensity of tremors can vary from mild to severe and may impact activities such as writing, eating, or holding objects steady.

Risk Factors

Several factors may increase the likelihood of developing multiple Sclerosis (MS) tremor, including the duration and severity of multiple sclerosis, other MS symptoms such as muscle weakness or spasticity, and individual differences in the location and extent of nerve damage.

Diagnosis

Diagnosing MS tremor involves a comprehensive evaluation by a healthcare professional, including a detailed medical history, neurological examination, and possibly imaging tests such as magnetic resonance imaging (MRI) to assess for brain lesions characteristic of MS.

Treatments for Multiple Sclerosis (MS) tremor

Managing tremors associated with multiple sclerosis (MS) can be challenging, as there are no specific medications designed solely for this purpose. However, research shows that some drugs doctors use in treating other conditions also alleviate tremors in some individuals with MS. These medications may be prescribed by doctors to help manage MS tremors:

1. Acetazolamide (Diamox): Originally developed to treat glaucoma and altitude sickness, acetazolamide has shown some effectiveness in reducing tremors associated with MS.
2. Buspirone (Buspar) and Clonazepam (Klonopin): These medications, classified as anti-anxiety drugs, may help alleviate tremors in some individuals with MS by calming the nervous system.
3. Hydroxyzine (Atarax, Vistaril): An antihistamine, hydroxyzine, doctors use this to manage tremors in MS patients, although its effectiveness may vary among individuals.
4. Isoniazid (INH): Doctors use this drug to treat tuberculosis, isoniazid has been explored as a potential option for managing MS tremors, although its mechanism of action in this context is not fully understood.
5. Primidone (Mysoline): Primidone, a medication primarily used to control seizures, has been found to help reduce tremors in some MS patients.
6. Propranolol (Inderal): Propranolol, a beta-blocker commonly prescribed for heart problems, high blood pressure, and migraines, may also be effective in reducing tremors associated with MS.

Non-medicinal treatments

Non-medicinal treatments for tremors associated with conditions like multiple sclerosis (MS) can offer valuable support in managing symptoms and improving quality of life. Here are some options:

1. Braces: Braces can provide stability to joints affected by tremors, helping to reduce extra movement. They can be used on various parts of the body, including the ankle, foot, arm, hand, or neck, depending on the location of the tremors.
2. Deep brain stimulation (DBS): While primarily used for individuals with tremors related to Parkinson’s disease, DBS is an experimental treatment option that involves the implantation of electrodes into the brain. These electrodes are connected to a device in the chest that delivers signals to the brain to help alleviate tremors.
3. Medical cannabis: While research on the effectiveness of cannabis in managing tremors is limited and mixed, some individuals may find relief from their symptoms with cannabis-based treatments. However, it’s essential to discuss this option with a healthcare professional to weigh the potential benefits and risks.
4. Physical therapy: Physical therapy can offer exercises aimed at increasing range of motion, improving posture and balance, and enhancing overall stability, which may help manage tremors.
5. Speech therapy: For individuals experiencing tremors affecting the lips, tongue, or jaw, speech therapy can provide techniques to slow speech, improve clarity, and control volume.
6. Occupational therapy: Occupational therapists can assist in identifying and implementing adaptive or assistive devices to help with daily tasks such as reaching, grasping, dressing, and eating.
7. Weights: Adding weights to affected body parts or commonly used items like utensils, canes, or walkers can provide stability and reduce tremors during tasks.

Home Care Tips

In addition to medical interventions, individuals with MS tremor can benefit from implementing certain lifestyle modifications and home care strategies to manage their symptoms. These may include:

• Engaging in regular physical activity to improve muscle strength and coordination.
• Practicing relaxation techniques such as deep breathing or meditation to reduce stress levels, which can exacerbate tremors.
• Using adaptive tools or assistive devices to compensate for tremor-related difficulties with daily tasks.
• Maintaining a balanced diet rich in nutrients to support overall health and well-being.

Prevention

While there is no known way to prevent MS tremor from occurring, early diagnosis and appropriate management of multiple sclerosis can help minimize its impact on daily functioning and quality of life.

When to See a Doctor

Suppose you experience persistent or worsening tremors, particularly in conjunction with other neurological symptoms such as weakness, numbness, or difficulty with coordination. In that case, it is important to consult a healthcare professional for evaluation and appropriate management.

Outlook/Prognosis

The prognosis for individuals with MS tremor varies depending on the severity of their symptoms and their response to treatment. With proper medical care, lifestyle modifications, and support, many people with MS tremors can effectively manage their symptoms and maintain a good quality of life.

Sources

• National Multiple Sclerosis Society. (n.d.). Tremor.
• Mayo Clinic. (2022). Multiple sclerosis.
• Multiple Sclerosis Society UK. Tremor.
• National Institute of Neurological Disorders and Stroke. (2019). Multiple sclerosis: Hope through research.
• National Multiple Sclerosis Society. Tremor.
• Multiple Sclerosis Association of America. Tremor.
• Cleveland Clinic. Deep Brain Stimulation: Overview.