Taming Tremor Associated with Multiple Sclerosis

Tremor is tough — of all the symptoms of Multiple Sclerosis (MS), it's probably the one with the least satisfactory treatment options. It's a close relative of the balance problems caused by demyelination in the cerebellum. The most common tremor in MS is called an intention tremor. This type of tremor is a relatively slow back-and-forth movement of the hands, arms, or legs that occurs when you make a purposeful (intentional) movement, such as reaching out to pick something up. When your doctor has you do the finger-to-nose test (touching your index finger to the tip of your nose several times rapidly), he or she is looking for tremor.

Folks with tremor can have a difficult time with daily activities, so it's important that you find healthcare professionals (generally a neurologist and an occupational therapist) who'll work with you to find a solution. The following strategies are used for managing tremor:

• Medication: The challenge here is that many of the medications that have been used to manage tremor are also pretty sedating, so you may be trading tremor for sleepiness. The trick is to start with a low dose and work up gradually until you get some relief. You may need to try several different types of medication before you find something that works for you. Here are some of the most commonly used medications:

• Atarax (hydroxyzine): Antihistamines such as this one may be useful if your tremor is worsened by stress.

• Klonopin (clonazepam): The sedating properties of this drug may help to calm the tremor down.

• Inderal (propranolol): This beta-blocker works for some people, but it's generally more useful with the other kinds of tremor that aren't seen in MS.

• Zofran (ondansetron): This antinausea medication works pretty well but costs a fortune.

• Mysoline (primidone): This highly sedating medication, which has some antiseizure properties, sometimes helps when nothing else does.

• Topamax (topiramate): This migraine medication, which is also used to treat certain non-MS tremors, may provide some benefit for intention tremor.

As you can see, the medication options aren't great, but they're all worth trying.

• Mechanical options: Such options — which use physical or behavioral strategies rather than medicinal ones — are offered by your occupational therapist (OT). Consider these tips:

• Stabilizing your forearm against your body, a table, or a chair may be helpful because the tremor typically involves the entire arm.

• A brace may help reduce unwanted movements in your wrist during particular tasks such as writing or eating, but the brace should be removed after the activity is finished. Wearing the brace full-time would reduce mobility in your joints and lead to weakened muscles.

• Weighting, an option in which you attach light weights to your wrists or ankles, provides stability and cuts down on your tremor. You can also add weight to the object you're using. Weighted utensils, for example, can make eating easier, while a heavier pen can improve your writing. Additional weights, of course, are more tiring to use, so you need to balance your need for stability with your need to conserve energy.

Unfortunately, none of these options eliminate tremor. Instead, your goal is to find the strategies that minimize its impact on your daily activities.

For people with a severe tremor that hasn't been helped by any of these medications or mechanical strategies, a technique called deep brain stimulation (DBS) may be helpful. DBS involves brain surgery to implant wires deep into specific brain regions that control movement. The wires are attached to an internal pacemaker-like device that can be programmed according to the person's need. This device is currently approved by the FDA only for Parkinson's disease, but it has been used successfully in some people with MS.

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