Getting a Handle on MS Tremors and Shakes

Some 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 coordination of movements, according to the National Multiple Sclerosis Society (NMSS).

How much they affect a person’s life varies from one individual to another. Some people find that tremors make certain tasks, such as writing, using a computer, dressing, and eating, very challenging. For others, tremors can be less disabling and more of a tolerable inconvenience.

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 clinical assistant professor at the NYU Grossman School of Medicine in New York City.

“In MS, these tremors reflect more aggressive or long-lasting disease,” Dr. Gutstein says.

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

Intention tremor typically occurs during physical movement; there is no shaking when you are at rest, according to the NMSS. The tremor develops and becomes more pronounced as you attempt to grasp or reach for something, or move a hand or foot to a certain spot. "These occur when you reach for something and start to shake,” Dr. Serra says. Intention tremors are the most common and typically most disabling tremor experienced by people who have MS, notes the NMSS.

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, per the NMSS.

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 disease-modifying therapies (DMTs) for MS that can prevent most tremors from ever occurring, he says. “As of 2022, there were 16 approved DMTs 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, antinausea medication, and antiseizure drugs have all been used for tremors caused by MS. These drugs are used off-label, meaning the FDA has not approved them to treat tremor related to 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. Electrodes are implanted in the brain to block involuntary muscle movement, Serra explains.

“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 the journal Movement Disorders found that cannabinoid-based therapies probably had no benefit for tremors in MS.

A review of reviews published in February 2018 in Neurology of Systemic Diseases concluded that cannabinoids may have modest effects in MS for pain or spasticity, but few reviews reported any benefits for other symptoms, such as tremors.

“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.

View the companion visual Web Story on How to Manage MS Tremors and Shakes.