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Tremor is another common symptom of multiple sclerosis, characterized by a person’s inability to control shaking.

This involuntary reaction can manifest itself in several parts of the body, which has made it possible to classify it into multiple categories. These tremors are often referred to as ataxia, which is a Greek term that means “lack of order”. However, ataxia is an independent symptom of MS, and it’s rather related to gait. It is how balance problems manifest themselves, causing MS patients to move as if they were drunk.

Why tremor occurs

A very rough explanation of this phenomenon is that nerve pathways are damaged, causing the body to be unable to control movement. These damaged areas are also referred to as plaques, and they are often accompanied by other types of symptoms related to multiple sclerosis.

When an MS patient begins experiencing tremors, they can also start showing signs of speech difficulty or swallowing. That’s because the aforementioned activities are related to the same nerve pathways that cause problems in coordinating movement.

Naturally, there are also some psychological implications to suffering from tremors. Instead of opening up and accepting that there are coping mechanisms to turn to, MS patients that begin experiencing tremors will often prefer isolation, as they see this failure to coordinate their movements as an embarrassment, and would prefer living secluded to deal with this issue on their own. This isolation can often lead to depression. Psychological assistance can go a long way in showing MS patients that tremors and nothing to be ashamed of, and that isolation is not a long-term solution.

Types of tremor

Because tremors can occur in different body parts, they have been classified into several categories, in order to get a better understanding of how they work:

  • Intention tremors are common when the MS patient is moving. It is considered the most common and frustrating form of tremor, because it only manifests itself when the patient is actually trying to perform a normal activity, such as walking, or reaching to grab a certain object.
  • Postural tremor is a form that occurs when certain parts of the body are supported or leaned against gravity. This means that postural tremor can appear when a person is sitting down, but doesn’t manifest itself when they are lying in bed.
  • Resting tremor is mostly typical in patients that suffer from Parkinson's disease. Resting tremor becomes more intense when the patient is resting, and will be significantly reduced when that person moves around.
  • Nystagmus is the uncontrollable movement of the eyes, whether vertical or horizontal. This type of tremor can be mild or severe, causing problems when looking to the side, or completely impairing vision. Also known as “jumping vision”, this type of tremor could be alleviated by certain forms of medication.

Tremor assessment

From mild to severe, tremor is something that can drastically affect a patient’s abilities to get through daily activities. It’s important to properly assess it, in order to create an individual therapy plan. When examined, a patient will require to provide information related to their condition, as well as the tremor.

Some of this information may include:

  • The body part which seems to be most affected by tremor.
  • Identifying the type of tremor, by analyzing the body’s posture or specific activity that triggers the tremor (e.g. when sitting down, reaching to grab an object, walking, etc.).
  • Discovering the level of degree in which arms or legs are affected by the tremor. For example, people can experience tremor in just one of their two arms, or it can affect the hands without affecting the wrists. The purpose is to narrow down the source of the tremors as much as possible.

Tremor surgical treatment

MS tremor can be treated by opting for one of the two different types of surgical interventions. The first type of procedure is called a thalamotomy. It’s implies inserting a wire into the thalamus (part of the brain where nerve cells reside). The end of the wire that goes in is heated, looking to disrupt the nerve cells in that specific spot.

The second procedure is called “deep brain stimulation”. It implies inserting a wire into the thalamus, but with the purpose of connecting it to a pacemaker that’s inserted near the collarbone. This pacemaker can send small electrical current stimulants that block the nerve cells.

While both of these of these surgical interventions are good at reducing tremors caused by MS, they also imply a series of risks. Some of these risks include brain hemorrhage, strokes, or even death. It’s also important to note that these interventions will not cure just any type of tremor, and the MS patient needs to be well and stable enough to undergo surgery.

Another important consideration is the fact the benefits of both these interventions are limited, and they will wear off in about half a year. Communication with the neurologist and neurosurgeon is very important, in order to determine if any of these procedures is truly recommended for the patient.

Tremor medication treatment

Tremor is one of the symptoms of MS that’s most difficult to deal with. That’s because treatment is quite tricky, and may not function for every patient.

Some of the most successful forms of medication for MS patients include:

  • Antihistamines (Vistaril, Atarax)
  • Anticonvulsive medication (Mysoline)
  • Anti-anxiety medication (Klonopin, Buspar)
  • Beta-blockers (Inderal)

Conclusion

Proper assessment when the first symptoms of tremor appear is very important. In turn, this helps develop a treatment plan in the early stages of tremors. Treatment can be varied: from prescription drugs, to different forms of surgical interventions. In some cases, assistive devices can be a great help, but choosing the right one implies receiving help from a specialist.

There have been cases where MS patients that suffer from tremors used weight to compensate for this condition, by inhibiting it. A more controversial form of tremor treatment is the use of tetrahydrocannabinol, which is the active ingredient found in the drug commonly known as marijuana. However, there are few and inconclusive studies conducted on the matter, so it can’t be considered an effective form of treatment yet.

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