Understanding Multiple Sclerosis Tremors
Of all the possible symptoms of multiple sclerosis (MS), I'm lucky enough not to suffer too badly with tremors.
I do have the occasional issue with my legs when I've been sitting for a while, and I transfer onto my scooter though. Sometimes one, or both, of my legs will wobble uncontrollably, and it's necessary to slap my hand onto the offending leg to stop it shaking.
My tremors can make me feel self-conscious, but it's only ever happened to me at home. So far, so I've been spared the embarrassment of a public wobble!
What Is a Tremor?
Tremors are a shaking or trembling movement you're unable to control. Usually, they consist of side to side shaking that is rhythmic, but they can also be unpredictable and irregular.
They can be either "fine" small movements or "gross" larger movements.
When I think of tremors, I associate them mostly with Parkinson's disease, where the tremors are constant, leaving the sufferer unable to eat, drink, or write unaided. I remember watching Mohamed Ali holding the Olympic torch while it seemed like tremors gripped his whole body. It must be a frustrating and disabling symptom to live with.
Unfortunately, it's not uncommon in MS either, and some of us experience constant tremors like Mohamed Ali or sporadic, unpredictable tremors like I described above. They can attack us anywhere, so for some of us, our legs can be affected while others have tremors in their hands, feet, or arms.
Four Types of Tremors
- Intention tremors can occur at the end of a task such as reaching for something or placing afoot somewhere. My tremor when transferring onto my scooter is an intention tremor, and it usually stops after a few seconds.
- Postural tremors will happen when a person is either standing up or sitting down where the body is working against gravity. They will usually stop when the person is laying down.
- Nystagmus tremors affect the eyes, causing jerky movements.
- Resting tremors are constant and occur when the person is at rest. It is a common tremor found in people who suffer from Parkinson's disease.
For many MSers, these tremors occur mainly at night, causing difficulty sleeping or staying asleep.
What Causes Tremors in MS?
Tremors are caused due to damage in the myelin, the protective coating around the nerves. Damage in the area of the brain called the "cerebellum," and the nerves leading to and from it can cause a tremor in MS. The cerebellum controls your coordination and balance, smoothing out the movement of your limbs, eyes, and speech. Damage to other areas of the brain that controls movements can also cause tremors such as the thalamus and basal ganglia.
As with other symptoms of MS, tremors can come and go, be progressive or be as a result of a relapse which you may fully recover from.
How to Cope with Multiple Sclerosis Tremors
Tremors can be difficult to manage, and there is no single approach that works for everyone. Managing tremors will depend on the severity and frequency of the tremor, and how much of an impact it's having on your life. My tremors are infrequent and short-lived, so I don't have any treatment at the moment.
- Drug treatments - Many MSers, I've spoken to online, use various medications at night to help control their tremors – such as gabapentin, baclofen, and duloxetine. Unfortunately, there are no specific drug treatments available for multiple sclerosis tremors. However, medications used for nerve pain may provide some relief, and its usually trial and error to find what works for you.
- Cannabis - Some MSers swear by cannabis as a treatment for nerve pain and tremors. While anecdotally there is lots of evidence that cannabis can help multiple health conditions, there isn't as much scientific evidence on its effects on tremors. Research is happening all the time though, and attitudes to cannabis may be different where you live, so it's worth further investigation.
- Rehabilitation – physiotherapists and occupational therapists can assess the problems tremors are causing and suggest ways to manage them. They will concentrate on posture, balance, alignment, and core strength, amongst other things.
- Small lifestyle changes – Make some small day-to-day alterations may make life easier when living with tremors such as the following;
- Clothes – Avoid fiddly zips and fasteners.
- Cutlery – You can buy special cutlery that makes eating easier.
- Food – Avoid soups or difficult pasta dishes.
- Drinks – Use a straw or plastic cup with a lid.
- Adaptive technology – Use voice recognition software instead of typing.
It's not clear exactly how many people with MS suffer from tremors, but it's thought as many as 60% may experience this symptom at some point.
Part of the unpredictable nature of MS means we never know when something like this may occur so talk to your health care team if you're finding tremors challenging to live with.