Need to Know: What Is a Tremor?

by Tamara Sellman | April 11, 2019

Photo by Shutterstock

Editor’s note: “Need to Know” is a series inspired by common forum questions and comments from readers. Have a comment or question about MS? Visit our forum. This week’s question is inspired by the forum topic “Tremors Caused by MS” from April 30, 2018.

What’s shaking?

If you have MS, your answer is likely to refer to at least one part of your body. Tremor describes an uncontrolled, rhythmic movement like shaking or twitching. It’s a symptom that as many as 75 percent of people with MS experience.

For some, tremor is a minor nuisance, but for others, it can be a major occurrence. Those with severe tremor (up to 6 percent of all people with MS) may need treatment to reduce its impact on daily living.

What causes tremor in MS?

MS causes misfiring of brain signals to different parts of the body.

In the case of the muscles, signals from the brain may become confused (thanks to demyelination) and result in repetitious relaxing and contracting of muscle groups that typically work opposite one another. This causes the rhythmic movements characteristic of tremors.

MS tremor: 4 types

There are four main types of MS tremor:

Intention tremor

These occur following a smooth movement by the hand or foot. A person with an intention tremor may reach for a cup of coffee, only to find their hand beginning to shake when they grasp the cup’s handle.

Discuss the latest research in the MS News Today forums!

Postural tremor

When a person with postural tremor stands up or sits down, the weight-bearing motion in between leads to “antigravity” shaking.

Nystagmus tremor

You know this type of tremor as the one that seizes your eyelid and makes it twitch uncontrollably.

Resting tremor

Simply put: This happens when your body is at rest. Resting tremor characterizes Parkinson’s disease, but it can also happen to people with MS.

New research on measuring tremor

It’s clinically important to measure tremor severity if doctors are to treat it. Yet, it’s difficult to do so. Clinical observation and self-reporting are often the only way to assess this symptom.

Simply witnessing tremors doesn’t provide measurable data. Patients may be asked to pour water from cups, draw spirals, or demonstrate tremor-affected handwriting, but this only proves it’s a symptom. None of these efforts accounts for objective severity.

Scaling the severity of tremor in people with MS can drive research into adequate therapies that can reduce, or potentially eliminate, this disabling symptom.

Currently, treatments for tremor are limited to a handful of off-label medications and the use of limb weights to counteract tremor movement. Experimental options include deep brain stimulation, alcohol, and THC.

Some measurement tools do exist, such as sensors that incorporate accelerometry. These sensors cull objective data on the amplitude, frequency, and occurrence of tremor activity. However, they’re hard to access, and most aren’t scientifically validated.

Another tool, the inertial sensor, can be wonky when it comes to trapping signal noise, which may or may not be a tremor, making data collected from these sensors difficult to interpret.

More of an issue with the current sensor options is that they are currently used to measure only the most common tremor found in Parkinson’s disease, resting tremor, and none have been tested against all forms of MS-related tremor.

Introducing electromagnetic motion tracking

Research published in the Journal of Neuroscience Methods in January highlights the possibility of an electromagnetic tracking sensor called TREMBAL that may be used to measure and rate tremor activity in people with MS.

This device, worn on the index finger, measures electromagnetic motion using four different kinds of sensors. To its advantage, it works without risking collection of random signal artifact.

With TREMBAL, the patient is hooked up to a sensor, then completes five 20-second exercises from which TREMBAL captures movement data.

If this sensor can adequately capture tremor, it can also adequately characterize it and inform treatment protocols for those with severe tremor activity. Stay tuned as the technology develops.

Do you experience tremor? How severe is it? Post your replies in the comments below or at the original “Tremors Caused by MS” forum entry.

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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.

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Comments

Melissa Vemi

I'm wondering I've noticed that my head moves and I can't stay perfectly still and I'm wondering if this might be a tremor? I've had multiple sclerosis for the last 20-plus years. I'm now secondary progressive.

Katrina Vesely

Not DX with MS here but was assessed for years (have had most of symptoms in the past), I do have a DX of essential tremors which when it was at my worst included my arms, head, trunk, and legs. Luckily, I haven’t had any tremors in a long time like well over a year. I do take medication.

Tamara Sellman

Hi Melissa
I feel like that is probably a question better directed at your neurologist. Tremor is a symptom of several kinds of neurological disorders, you will want to confirm it is related to MS or, if not, what it might be related to. Best wishes!
Tamara

Lynn Hornickel

I have PPMS and have developed a tremor in my left hand which has resulted in my becoming disabled and unable to work any longer. Doctors have offered no treatment. It is very frustrating.

Roel Hempenius

Hi,
I have been prescribed "propanolol" of which one of the side effects slows down a tremor.

Katrina Vesely

I have essential tremor diagnosis. Was assessed for MS for years, not enough evidence. When when I was first started on medication it was propanolol. It has since been increased and now Propanolol Extended release tabs. I did seem to notice more improvement with the extended release as I was only prescribed in the morning.

Karen Jacobs

I take the long acting propranolol. It does work. I tried the regular propranolol and I would only get maybe four hours out of it before my left hand would begin to tremor again. So I’m very please with the long acting one.

Ted

Ive been prescribed that to for social anxiety and benign essential tremor. Although if i take it every day withon 2 weeks it becomes ineffective. Therefore i only take it off and on.

Tamara Sellman

I'm sorry to hear this, Lynn. My tremor comes and goes (they're in my legs), but I have RRMS. I know when it pops up for me it's super frustrating, so to have to live with it all the time must be a total nuisance. I hope that, at the very least, you have been able to get disability due to being unable to work. Good luck to you <3 Tamara

Sharon Ferrillo

I HAD A DEEP BRAIN STIMULATOR PUT IN MY BRAIN IN 2011. IT WAS NOT SUCCESSFUL . IT HELPED A LITTLE BUT I STILL SHAKE. I DRINK WITH A STRAW, CAN'T WRITE, I FIND IT HARD TO EAT IN FRONT OF PEOPLE. I WALK WITH A WALKER CAUSE I SHAKE WHEN I TRY TO WALK. I USE AN ELECTRIC TOOTHBRUSH. M Y HUSBAND COOKS DINNER, CLEANS OFF THE TABLE, LOADS AND EMPTYS DISH WASHER. MORAL OF THIS STORY IS HAVE A GREAT CARE GIVER

Tamara Sellman

That's a great piece of advice! Let's hear it for the awesome caregivers in our lives!
Tamara

Vicki Lowrie

Like Sharon I drink with a straw, cant write, use an electric toothbrush and have so much difficulty eating that now I am forced to accept the help of others, very frustrating but fortunately all my friends know my problem and are always willing to help, far preferable to stabbing my face with a fork. And one of these friends is also my excellent caregiver and friend of 46 years. My hands are still until I intend to do something, then they shake uncontrollably. Diagosed in 1988, I have SPMS, now confined to a powered wheelchair

Robin Villardi

Any kind of stress will set my body into uncontrollable tremors and can last up to an hour before calming down. Mine are resting tremors for the most part, but even a cool breeze can set them off. Often I will wake having them as well. Klonopin helps. If I sit and try to concentrate on one little item (like looking thru the mini blinds) can set my head into motion.

Angela Marie Mayberry

Same. I'm on STD from my job as a project support specialist because the drive to work would set off symptoms. I've been informed that they will have to fill my position as it is too essential to keep open while I try to get the tremors under control. I'm trying CBD but don't like the lucid dreams it causes. Any other suggestions?

Tamara Sellman

Angela
looks like propanolol has been mentioned above, might be worth a shot! Keep us posted if you try it out.
Tamara

Stacey Guenther

I have a tremor and I always thought it was my anxiety until my doctor mentioned the tremor is caused by the MS. My handwriting is nearly indecipherable and I spill food everywhere when I eat. It’s embarrassing.

Tamara Sellman

Yes, Stacey, my handwriting gets really bad when I do have tremors in my hands, it's hard to even hold a writing instrument (or a cup of coffee). For me, it comes and goes, and I love it when my hands work, handwriting for me is kind of meditative and pretty, so when my hands are all shaky, I too find it indecipherable and unpleasant.
Tamara

Betty Tuxhorn

Have tremors when on computer, shaking when trying to point the mouse where it should go and handwriting indescribable

Étienne Tremblay

Hi, My tremor is intention. I have ppms. I also make a mess when I eat and drink, I drop things, I can’t draw anymore and my writing is a catastrophy :( !

Deborah Goldstein

I have a tremor in both hands and it comes and goes. I have tremors in both legs at times. I hate this. It is not constant, but I no longer eat soup in public because I cannot guarantee that I can eat neatly. It makes my life frustrating. Handwriting has degraded. Typing can be awkward.

Bert

I have RRMS. My tremors are in my lips and chin. It is not terrible but my family and coworkers have noticed it. My hands shake when I’m tired.

Tamara Sellman

Hi Bert
Thanks for chiming in, I think we forget that other parts of the body besides arms and legs may take on movement patterns all their own. I hope your family and coworkers are understanding! None of us want to be "noticed" in this way, but if we are, it should be fine among the people in our lives.
Tamara

Bree Miles

Hi I have not been checked for or diagnosed with ms but I have many of the symptoms. I have bad tremors when stressed or trying to use my hands to do anything. I thought it was my extreme anxiety but not so sure anymore.

Tamara Sellman

I hope you'll have your symptoms checked out soon, Bree. Don't delay, there are a number of different things that you might be encountering and they all have some sort of treatment. Waiting may only allow things to worsen. Good luck to you!
Tamara

Suzannah Whitfield

I have resting tremors, mostly in my right leg and mostly at bedtime. I wear Neupro 4mg/day patches for restless leg and take 400 mg of gabapentin/night, which helps most of the time. Sometimes, unfortunately, nothing helps, and I understand why animals caught in a trap chew limbs off. I usually end up taking another muscle relaxer, but it takes a couple of hours for it to kick-in.

Tamara Sellman

Thanks for sharing your experience and solutions (such as they are), I'm sure these are options some might not have considered at least at first. Best of luck to you,
Tamara

Laura

I had tremors so bad that my hands shake face twitches. Went to nephrologist they said it is ptsd. I have shaking all the time . my fingers do funking things.

Arica Therrien

I've been experiencing violent shaking spells and convulsions for nearly a decade. For the longest time, it was attributed to my severe anxiety, but my psychiatrist is starting to disagree, and after reading this article, so am I. My shaking has lasted upwards of 4 hours on many occasions abs it leaves me physically drained. I just had a shaking spell this morning to where my daughter had to help me dress after my bath.

Tamara Sellman

I'm sorry to hear this, Arica. The fatigue that follows is just awful, as well. Wishing you well, maybe you will find more answers.
Tamara

Pamela

Is this the same as clonus. My toes do a repeating up and down motion really fast

Yvette Calenda

When I am nervous or when I have to write or eat I have bad tremors. At night when I go to sleep my head shakes terribly.?

Kessa

I've had a resting tremor in my ring finger since i was 19 y/o. I wasn't diagnosed with MS until I was 41. I now have, when stressed, severe tremors, so bad that it looks like and feels like shivering. I also have tremor in my arms and thighs. Weird stuff.

Suprena Flamand

I have been diagnosed with MS for ten years. I have tremors, my eye twitches and I get twitches in my hands sometime when working on my phone or a computer. Im not being treated for them I just deal with them lol.

Jimmy Etier

I have a tremor in my left thigh that runs from just below my hip to my knee. It is a real pain in the butt. It happens mostly when I'm at rest or laying down and trying to roll over

Jeannie

I have involuntary twitches. It's getting worse. I think it is when my body is at rest. I mentioned it to my neurologist but he blew it off. It worries me. I have pseudo tumor and restless leg syndrome. My neurologist said I have some characteristics of fibromyalgia but not diagnosed with it.

Debra Matthews

I was born with Tremors in my hands I inherited it from my mom. I’m 56 and it grows worse as I get older. I just started 40 milligrams propanol twice a day.
Helps a little

I wish there was more research for this for people with MS.

I use primadone
Hundred milligrams twice daily. I’ve used many of the other drugs in the past. It only helps by a hairline. I have SPMS. Diagnosed in 2019. Was RRMS prior since 2002.I wish there was more research for this for people with MS. Susan Fryc

Cazzy

Tremors are the bane of my life. Can't write or drink from a cup anymore - I have to drink from bottles with sports caps or use a straw - but even with this I will still miss my mouth! Nightmare! When I do drink alcohol, which is hardly ever, I use a straw or even transfer it to a plastic bottle. I wouldn't eat out again and have learnt to eat with my left hand. Trying to learn with my left hand too but even this has a mind of its own!
Anyway alcohol can help very slightly but it's not worth it for me really because I always feel an even whole lot worse the next day! ?
Keen to try some beta blockers as this is the thing I haven't yet tried but I am worried about side effects (?). CBD didn't help and neither did Gabapentin.
Cheers x

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Need to Know: What Is a Tremor?

What’s shaking?