Microsoft word - tremor.doc

National MS Society
Information Sourcebook

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—generally is greatest during physical movement; there is no
shaking when a person is at rest. The tremor develops and becomes more pronounced as the person tries to grasp or reach for something, or move a hand or foot to a precise spot. This is the most common and generally most disabling form of tremor that occurs in people with MS. • Postural tremor—generally is greatest 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. • Resting tremor—generally is greatest when the body part is at rest and is
diminished with movement. More typical of Parkinson’s disease than MS • Nystagmus—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)—activities that 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 antihistimines Atarax® and Vistaril®
(hydroxyzine); the beta-blocker Inderal® (propranolol); the anticonvulsive medication
Mysoline® (primidone); a diuretic Diamox® (acetazolamide); and anti-anxiety drugs
Buspar® (buspirone) and Klonopin® (clonazepam).
Weights and other devices can also 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.
More recently, deep brain stimulation (using electrodes implanted surgically into various
brain areas) has been shown to be effective for the management of tremor in Parkinson’s
disease. This has also been tried in MS patients (with varying degrees of success)
although, at the moment, this therapeutic approach should be regarded as experimental.
Tremor can have significant emotional and social impact, 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. See also…
Society Web Resources
Coyle P., Halper J. Meeting the Challenge of Progressive Multiple Sclerosis (3rd ed.).
New York: Demos Medical Publishing, 2001.
—Ch. 4 Managing the Symptoms of Progressive Multiple Sclerosis
Schapiro R. Managing the Symptoms of Multiple Sclerosis (4th ed.). New York: Demos
Medical Publishing, 2003.
—Ch. 6 Tremor and Balance
The National Multiple Sclerosis Society is proud to be a source of information about multiple
sclerosis. Our comments are based on professional advice, published experience, and expert
opinion, but do not represent individual therapeutic recommendations or prescription. For specific
information and advice, consult your personal physician.
To contact your chapter, call 1-800-FIGHT-MS (1-800-344-4867) or visit the National MS Society
web site:
2005 The National Multiple Sclerosis Society. All rights reserved. Last updated December 2005


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