Getting a Handle on MS Tremors and Shakes

Many people with multiple sclerosis (MS) develop tremors, or shaking, in various body parts. Tremors can be mild, but they can also be severe and disabling.

"MS tremors are rhythmic, back-and-forth muscle movements that you can't control,” says Alessandro Serra, MD, PhD, a neurologist at University Hospitals Cleveland Medical Center in Ohio. “The tremor can affect your hands, arms, legs, or even your head and vocal cord muscles."

People with MS get tremors when plaques, or damaged areas, develop along the nerve pathways responsible for voluntary muscle movement and balance.

How much of an impact they have on a person’s life varies from one individual to another.

Dario Anastasio, 62, of Newington, Connecticut, had to give up his job as a computer systems engineer because of his tremors.

“Before I was diagnosed with MS, I would have tremors in my hands, but I could still write and use a computer,” Anastasio says. The tremors worsened after his 2007 diagnosis with MS.

Linda Roudebush, 62, of Austin, Texas, is not so troubled by the tremors in her left hand. “I am right-handed,” she says. “So the tremor in my left hand is an inconvenience, but not all that bothersome. I don’t take anything for it, and I use the shaking hand to scratch an itch or give a back massage,” she jokes.

Different Types of Tremors

Tremors are commonly classified by appearance and cause or origin:

Cerebellar tremor, the kind most often associated with MS, is a slow tremor of the extremities "caused by lesions in or damage to the cerebellum in the brain,” says Harold Gutstein, MD, a MS neurologist at NYU Langone Health in New York City.

“In MS, these tremors reflect more aggressive or long-lasting disease,” Dr. Gutstein says. Cerebellar tremors tend to occur at the end of purposeful movement, such as pressing an elevator button with a finger.

Tremors are also described according to the situations in which they occur:

Intention tremor tends to occur at the end of a purposeful movement, such as touching a finger to the tip of your nose. "These occur when you reach for something and start to shake,” Dr. Serra says.

Postural tremor occurs when you’re holding a position against gravity, such as holding your arms outstretched. "With these tremors, you shake when you sit or stand,” Gutstein says, “but not when you’re lying down.”

Resting tremor occurs at rest and is more common in Parkinson’s disease than in MS, but it does occur in MS.

How to Prevent MS Tremors

Gutstein often tells his patients: “The brain is like time: Once it disappears, you’re not getting it back.”

The important thing is to get diagnosed and get early, aggressive treatment with available disease-modifying MS drugs that can prevent most tremors from ever occurring, he says. “There are about 15 medications now for the treatment of MS, and some of them are very effective.”

To minimize tremors, “you should also eliminate contributing factors that can be controlled, like fatigue, stress, or too much coffee,” Gutstein says. “There are no great treatments for MS tremors once they start, which is why prevention is so important.”

How to Cope With MS Tremors

For those who have already developed tremors, treatment may include the following:

Occupational or physical therapy can help you manage tremors that interfere with daily life. These therapies may include the use of braces, weighted devices, wrist rests, and exercises to increase control and balance, Serra says.

Medication, including anti-anxiety drugs, antihistamines, beta-blockers, anti-nausea medication, and anti-seizure drugs have all been used for tremors caused by MS. “No drug has been specifically approved for MS tremors," Serra says. “None of the available MS drugs treat tremors, either.”

Deep brain stimulation, a therapy often used to treat Parkinson's disease, may also be helpful for cases of severe MS tremor. It involves implanting electrodes into the brain to block involuntary muscle movement, Serra explains.

Anastasio underwent deep brain stimulation on the left side of his brain to control the tremors on the right side of his body. “I can now hold my right hand without shaking, but my left one still has tremors,” he says. He has not decided whether to have the treatment on the other side of his brain.

“Deep brain stimulation shows promise,” Serra says, “but the improvements are not always dramatic enough to justify the risks.” Those include infection and bleeding in the brain, he says.

Botox, which is approved to treat MS-related spasticity in the upper and lower limbs, as well as overactive bladder, may also help treat MS-related limb tremors. In a study published in the journal Neurology, 23 people with MS showed improvement in tremor severity in their arms as well as in their writing and drawing ability six weeks and three months after Botox shots.

When injected into a muscle, Botox blocks nerve signals that cause tightening and movements of the muscle. Its effects last between two and six months.

What About Medical Marijuana for MS Tremors?

Medical marijuana has not yet been proven to help with tremors, Gutstein says.

Indeed, a review of clinical and preclinical research on marijuana and other chemicals (cannabinoids) derived from the cannabis plant published in February 2015 in the journal Movement Disorders found that cannabinoid-based therapies probably had no benefit for tremors in MS.

“There is a lot of noise out there,” Gutstein says, “but [no evidence directly related to] cerebellar lesions. It’s a step I wouldn’t cross at this point.”

Additional reporting by Susan Jara.