Tremors
Many people with MS experience some degree of tremor, or uncontrollable shaking. It can occur in various parts of the body.
There are several types of tremor:
- Intention tremor means there is no shaking when a person is at rest. The tremor develops and becomes more pronounced as the person tries to reach or grasp something or move a hand or foot to a precise spot. This is the most common and generally the most disabling form of tremor that occurs in people with MS.
- Postural tremor occurs when a limb or the whole body is being supported against gravity. For example, a person who has a postural tremor will shake while sitting or standing, but not while lying down.
- Nystagmus is a tremor that produces jumpy eye movements.
Tremor occurs because there are plaques-damaged areas-along the complex nerve pathways that are responsible for coordination of movements. People with MS who have tremors may also have associated symptoms such as difficulty in speaking (dysarthria) or difficulty in swallowing (dysphagia). These activities are governed by many of the same pathways involved in coordinating movement.
Tremor is One of the Most Difficult MS Symptoms to Treat
Tremor is considered by physicians and other health professionals to be one of the most difficult symptoms to treat. To date, there have been no reports of consistently effective drugs for tremor.
Varying degrees of success have been reported with agents such as the anti-tuberculosis agent, isoniazid (INH); the antihistamines Atarax and Vistaril (hydroxyzine); the beta-blocker Inderal (propranolol); the anticonvulsive Mysoline (primidone); a diuretic Diamox (acetazolamide); and anti-anxiety drugs Buspar (buspirone) and Klonopin (clonazepam).
Weights and other devices can be attached to a limb to inhibit or compensate for tremors. An occupational therapist is the health professional who can best advise about assistive devices to aid in the management of tremor.
Tremor can have emotional and social impacts, especially when people choose to keep to themselves rather than be embarrassed by tremor. Isolation can lead to depression and further psychological problems. A psychologist, social worker, or counselor may be able to help a person with MS deal with these issues and become more comfortable in public.
Controversy continues over the role of alcohol or tetrahydro-cannabinol (THC), the active ingredient in marijuana, in treating tremor. Only small studies have been done, characterized by conflicting results. Marijuana remains a controlled substance under current policies of the U.S. Drug Enforcement Agency.
In the most severe types of tremor, surgical procedures are sometimes used. A thalamic implant, originally developed for Parkinson's disease, is being tried in MS. While relief of tremor using this method has been seen in some individuals, the outcomes are not always predictable and their role in severe tremor is still being determined. In the meantime, thalamic implants are considered "experimental" and may not be covered by most insurance policies.
Source - The MS Information Sourcebook produced by the Information Resource Center and Library of the National Multiple Sclerosis Society. © 2001 The National Multiple Sclerosis Society. All rights reserved. Reproduced with permission.
