Dealing with Tremor 1 of 2　

Types and causes of tremor
　

Tremor, defined as an involuntary rhythmic shaking of a body part, affects between 25% and 60% of people with  Multiple Sclerosis. MS tremor tends to affect the limbs, the head and neck, the vocal cords, and the trunk of the body. It can interfere with the ability to do everyday activities such as speaking, swallowing, writing, and walking.

It's difficult for scientists to tell exactly why people with MS experience tremor. Because MS affects so many different parts of the brain, it's hard to link the tremor to a single damaged area. However, they do know that MS tremor results from MS-related damage to areas of the brain that control movement.

People with MS may experience a variety of different kinds of tremors. The most common type of tremor in people with MS is intention tremor. Intention tremor occurs only during movement, not when a person is at rest. Intention tremor develops and gets worse as the person tries to move their body parts towards a specific target (e.g., reaching for objects, writing). It is worst during small, intricate movements, such as those needed for handwriting.

Postural tremor is a type of tremor that occurs when people are trying to support their own weight against gravity. This means it would not occur when a person is lying down, but it could happen when they are sitting or standing.

Rest tremor is not common for people with MS. This type of tremor occurs when someone is at rest. In other words, it happens when they are not moving a body part or supporting it against gravity.

Nystagmus is a type of tremor that affects the eye muscles, leading to uncontrolled eye movements.

MS tremor can range from mild to severe. When tremor is very severe, leading to large back and forth motions of the affected body part, it is called gross tremor.

　

　

Medications and surgery for tremor

　

 MS-related tremor can be difficult to treat, but there are many different ways to manage it, including occupational and physical therapy, medications, and surgery.

A wide variety of medications have been studied for the treatment of MS tremor, including antihistamines, anti-anxiety medications, diuretics (pills that make you urinate more often), beta-blockers (medications that have a variety of effects in the body and are also used for high blood pressure), anti-spasticity medications, anti-tuberculosis, and even anti-seizure medications. Your doctor will advise you on which medication would be most appropriate for you based on your medical history and other medications you may be taking. You may need to try more than one medication before finding a medication (or combination of medications) that helps with your tremor.

Your doctor may recommend that you start a disease-modifying medication in addition to medication to help relieve your tremor. Disease-modifying medications won't directly affect your current symptoms of tremor, but they can help prevent future damage, which could help stop the tremor from getting worse.

Surgical procedures, such as thalamotomy and deep brain stimulation (DBS), have been used to treat MS tremor.

Thalamotomy uses a machine called a gamma knife to destroy nerve tissue in an area of the brain called the thalamus. Open-skull surgery is not needed. Although it may help in about two-thirds of cases, the benefits may disappear over time.

With DBS, open-skull surgery is performed to insert a small electrode in the thalamus. A wire is run to a control device in the chest area that sends electrical pulses to disrupt tremor-related nerve signals. DBS has been used for Parkinson's disease but it is still considered experimental for people with MS. For more information on surgery for tremor, speak to your doctor.