Tremor in multiple sclerosis

Written by James McIntosh | Last updated Aug. 11, 2026
green checkbox Reviewed by Mirla Ávila, MD

A tremor in multiple sclerosis (MS) is an intense, uncontrollable, and involuntary trembling or shaking that can affect a specific part of the body or the whole body.

MS tremors can occur when nerve fibers responsible for controlling movement and coordination are damaged, as well as when lesions develop in a specific part of the brain.

Tremors are one of the most common symptoms of MS, affecting 25% to 58% of people with the chronic condition.

What causes tremors in MS?

In people with MS, tremors can occur when damage to myelin — the protective, insulating sheath surrounding nerve fibers — and to the fibers themselves disrupts the nerve pathways that control smooth, coordinated movements.

If this damage appears in and around areas of the brain that are responsible for movement, balance, and coordination, it can lead to tremors.

Areas and nerve pathways involved in MS tremors may include:

  • the cerebellum and its connections, particularly the dentato-rubro-thalamic pathway
  • the thalamus
  • the basal ganglia, though these are a less common cause of tremor in people with MS

The four main types of MS tremors

There are four main types of tremor in MS:

  • Intention tremors: These occur during purposeful movement, such as reaching for an object, and may become more pronounced as the person gets closer to their target.
  • Postural tremors: These occur when a person holds part of the body in a position against gravity, such as holding the arms outstretched.
  • Rubral, or Holmes, tremors: These are slow tremors that may occur at rest and become more noticeable when maintaining a posture or making a purposeful movement.
  • Resting tremors: These occur when the affected body part is relaxed, and may lessen with movement; this type is less common in people with MS.

A condition called nystagmus causes the eyes to move repeatedly without a person controlling them. The movements may be side to side, up and down, or in a circle. This can make vision seem blurry or shaky. Although nystagmus may look like a tremor, it is not considered one.

How tremors affect daily life and safety

The degree to which MS tremors affect daily life can vary greatly depending on their severity. Tremors can be very mild and barely noticeable, or very strong. For many people with MS, tremors can be debilitating enough to severely affect quality of life.

MS tremors most commonly affect the arms and hands, but they also can involve the head, trunk, legs, or voice and, less commonly, the neck. In many people with MS, tremor is marked by shaking hands, which can occur alongside other tremors. The problems tremors cause depend on which part of the body is affected.

For instance:

  • Tremors in the arms may affect a person’s ability to do certain tasks with their hands.
  • Tremors in the trunk or legs can cause people to lose their balance and lead to mild to severe walking problems.
  • Tremors affecting the head can interfere with eating and drinking.
  • Tremors affecting the neck and vocal cords can cause speaking (dysarthria) or swallowing (dysphagia) difficulties.

In most cases, tremors occur without warning and can greatly affect a person’s well-being. They can occur during an ongoing activity that requires focus and motor control, such as driving, which may result in serious accidents.

Management and therapy options for MS tremors

Disease-modifying therapies (DMTs) can help prevent new MS lesions, which may reduce the risk of developing tremors and other movement disorders. Once a tremor develops, physical therapy, medications, and certain electronic devices may help manage it, although results vary from person to person. There is no treatment that specifically targets the underlying cause of MS tremors.

Physical and occupational therapy

People with MS can perform different types of exercises to reduce the incidence of tremors:

  • Patterning: This involves repeating a specific movement pattern to train the mind and improve coordination. Repeated movements can reinforce the connections between nerve circuits and improve coordination.
  • Vestibular stimulation techniques: These employ repetitive swinging, rocking, and spinning motions to train and acclimatize the balance centers in the brain.
  • Special equipment such as a Swiss ball: These tools can be used for balance exercises to improve overall movement and coordination.
  • Computerized balance stimulation: This requires the patient to listen to instructions and carry out specific movements while standing on a platform and receiving feedback.

Weights, stabilizing braces, and other devices that attach to the body to immobilize limbs can also create natural resistance against tremors.

Medications for MS tremors

Among medications commonly used to manage tremor are:

The responses to these medications can vary substantially, so prior consultation with a physician is highly recommended.

Advanced interventions and tracking research

Deep brain stimulation is a technique that involves electrically stimulating the brain region that initiates tremors and temporarily blocking its activity. It is being investigated for the management of MS tremors following some success in Parkinson’s disease.

Some other approaches that are being investigated to treat and manage tremors in people with MS include:

  • MRI-guided focused ultrasound
  • gamma knife radiosurgery
  • robot-assisted arm training

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.


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