MS can cause tremors, a type of rhythmic involuntary movement affecting different parts of the body, including the hands and arms. Treatment can involve physical therapy and medication.
A tremor is a rhythmic involuntary movement that looks like rapid and repetitive contractions and relaxations of a muscle.
People with MS can experience different kinds of tremors affecting different parts of the body, including the:
- arms
- hands
- vocal cords
- head
- torso
- legs
Tremor usually involves rhythmic shaking.
A 2020 review estimates that tremor affects between 25% and 58% of people with MS.
Keep reading to learn the different types of tremors that affect people with MS, such as action tremors and resting tremors, how to manage them, and what treatments may help.
Tremors from MS can involve:
- shaking
- trembling
- a shaky voice
Muscle jerking, twitching, and spasms are also very common movements in MS that are distinct from tremors.
Tremors can make daily activities like eating, drinking, or walking more difficult.
The type of tremor a person with MS has can affect when they experience it. But they can happen with movement or at rest.
Tremors after exercising
A person with MS may experience an increase in the intensity of their tremors after vigorous exercise.
Muscle tremors after exercising are also common for people who do not have MS, so don’t assume you have MS if your only symptom is tremors after exercising.
Muscle shaking after exercise can also occur due to:
- muscle fatigue
- low blood sugar
- dehydration or electrolyte imbalances
There are two primary types of tremors: resting and action.
Resting tremor
Resting tremor occurs when shaking happens when a body part is at rest. For example, a person may be sitting comfortably with their hands resting in their lap, but their fingers shake.
If a person with MS has a resting tremor, they may experience more tremors at night. However, resting tremors are more common in Parkinson’s disease than in MS.
Action tremor
Action tremor occurs when a muscle is being voluntarily moved. For example, a person may be reaching to pick up a glass of water, and their hand starts to shake.
There are a number of subclassifications of action tremor, including:
- Intention tremor: These are associated with physical movement. There is no shaking when a person is at rest, but a tremor develops and becomes more pronounced as they attempt to make a precise movement, such as shifting a foot to a specific spot or reaching for a cup.
- Postural tremor: These tremors are associated with moving or supporting against gravity, such as a tremor that develops while standing or sitting but not lying down. A postural tremor causes unwanted movement when a person is maintaining a certain posture, such as when sitting.
- Nystagmus: These tremors are associated with jumpy eye movements.
Action tremors are more common in MS than resting tremors, which are typical of Parkinson’s disease or anxiety.
Action tremors in MS are usually associated with muscle weakness or brain involvement.
While there isn’t a cure for tremors, people with MS may be able to reduce their amount or intensity with a combination of management strategies and medical treatment.
Lifestyle changes
Regularly getting enough rest may help decrease the occurrence of tremors.
Physical, occupational, and speech therapy
Physical and occupational therapists can help people with MS manage living with tremors by:
- teaching exercises for coordination and balance
- recommending stabilizing braces, if necessary
- demonstrating how to use weights to compensate for tremors
- teaching new ways of performing daily activities that MS tremors might make challenging
- helping prevent falls
- practicing swallowing or speaking
Medication
Healthcare professionals may prescribe botulinum toxin type A (Botox) injections to help manage tremors relating to MS.
If your tremor is due to other causes, treatment can include:
- beta-blockers, such as propranolol
- anti-anxiety medications, such as buspirone (BuSpar) and clonazepam (Klonopin)
- anticonvulsive drugs, such as primidone (Mysoline)
- tranquilizers, such as benzodiazepines, temporarily
Medical procedures
Some people with MS who have severe disabling tremors despite medication may be candidates for certain surgical procedures.
There are two types of surgery that may potentially help tremors in some people with MS:
- Thalamotomy is a surgery that destroys a part of the thalamus, a structure in the brain that helps control movements.
- Deep brain stimulation involves a doctor implanting a tiny electrode into the thalamus. The electrode is then attached to a wire that connects to a device under the skin in the chest area. The device delivers small electrical impulses to the thalamus.
However, there’s limited evidence that surgery could help in the treatment of MS-related tremors, and these procedures are not Food and Drug Administration (FDA) approved for treating MS-associated tremors. So, it’s unlikely that health insurance would pay for them.
Though some researchers may have observed some improvement, more research on whether these procedures improve quality of life is still needed. These treatments are more commonly used for other conditions that cause tremors, such as Parkinson’s disease.
If you’re interested in whether you might benefit from a surgical procedure for the treatment of MS tremors, speak with your doctor about enrolling in a research study.
Natural remedies
According to a
These may include:
Natural remedies for MS may help with symptoms such as:
- anxiety
- difficulty sleeping
- pain
- muscle spasms
Talk with your doctor before adding any herbal supplements to your routine. They can interact with medications you may be taking and can potentially cause side effects.
For people with MS, tremors are usually caused by brain lesions (specifically in the cerebellum) and damaged areas, called plaques, along the nerve pathways that are involved with coordinating movement.
Muscle weakness due to MS-related damage can also make movement difficult, contributing to MS-associated tremors.
The same plaques sometimes also result in other symptoms such as dysphagia (difficulty swallowing) or dysarthria (difficulty speaking).
Tremors can get worse over time and be more difficult to manage if a person already has poor eyesight or numbness in the body. Caffeine and anxiety can also worsen tremors in people with and without MS.
If you have tremors associated with MS, they can range from mild to severe and disabling.
While there is no cure for tremors yet, people with MS can potentially reduce their occurrence and improve function through physical and occupational therapy, medication, and lifestyle changes.
If you’re experiencing tremors for the first time or if your tremors get worse, it’s best to talk with your doctor.