Multiple sclerosis (MS) hands, also known as MS tremors, refer to tremors or uncontrollable shaking that can occur in the hands and arms of people with multiple sclerosis. Tremors are estimated to affect around 25 to 60 percent of those with MS. The tremors associated with MS are generally caused by damage to the areas of the central nervous system that control coordinated movements.
What causes MS hands tremors?
MS damages the myelin sheath that covers and protects nerve fibers. This damage slows down or blocks messages between the brain and other parts of the body, leading to symptoms of MS, including tremors. Specifically, tremors often occur when MS lesions form in the cerebellum, midbrain, brainstem, spinal cord pathways, and optic nerves. Interruption of signals along these neural pathways can cause loss of coordination and tremor.
Tremors associated with MS usually occur in the arms and hands, but can sometimes also affect the legs, head, and trunk. They may occur on one side of the body or on both sides.
What are the main types of MS hand tremors?
There are two main types of tremors that occur with MS:
- Intention tremor – This tremor gets worse when reaching for or using an object. It typically occurs when making purposeful voluntary movements such as reaching for a glass or writing.
- Postural tremor – This causes shaking when holding the hands and arms against gravity, such as when holding the arms extended. It may occur when holding a position for some time.
Intention tremors are one of the most common movement disorders seen in MS. Some individuals may experience a combination of both intention and postural tremors.
What are the symptoms of MS hand tremors?
Symptoms of MS hand tremors can include:
- Uncontrollable shaking or oscillating movements in the hands and arms
- Tremors that get worse when reaching for or holding objects
- Difficulty writing, eating, or holding objects steady
- Shaking that improves with rest
- Imbalance or loss of coordination in the hands and arms
- Fatigue in hand muscles
- Embarrassment or frustration over inability to control tremors
The tremors are often mild at first but can worsen over time. Stress, fatigue, overheating, and certain medications may also exacerbate MS tremors.
How are MS hand tremors diagnosed?
MS tremors are usually diagnosed based on a neurological exam by a doctor. The doctor will assess the pattern, type, and severity of the tremors. They will also review the person’s full medical history and perform tests to rule out other potential causes of tremors.
Some tests that may help diagnose MS tremors include:
- Blood tests
- MRI or CT scan of the brain/spinal cord
- Nerve conduction studies
These tests allow doctors to check for any nerve damage or demyelination consistent with MS tremors. In some cases, the doctor may also order thyroid function tests to rule out hyperthyroidism as a cause.
How are MS hand tremors treated?
While there is no cure for MS tremors, various treatments can help reduce symptoms. Treatment options may include:
- Medications – Drugs like isoniazid, propranolol, or primidone can help dampen tremors in some cases.
- Botox injections – Injecting botulinum toxin into affected muscles may provide temporary improvement.
- Occupational therapy – OT can teach exercises and techniques to strengthen hands and improve coordination.
- Adaptive devices – Items like weighted utensils, wrist braces, and writing aids provide extra stability.
- Relaxation techniques – Stress reduction through yoga, meditation, or massage may minimize tremors.
- Avoid triggers – Preventing overheating and resting when fatigued can help reduce tremors.
A combination approach focusing on medications, adaptive devices, and lifestyle changes often works best. Treatment should be tailored to each individual based on the severity of their tremors.
What is the outlook for people with MS hand tremors?
The prognosis for MS tremors varies considerably between individuals. Mild intention tremors often respond well to treatment. However, tremors tend to get worse over time without treatment. Severe tremors can make it very difficult for a person to work, write, eat, or drink.
While tremors cannot be cured, they can often be well-managed through ongoing treatment. With the right approach, most people can find ways to successfully manage their tremors and minimize disruption to daily activities.
Working closely with a neurologist and occupational therapist allows people with MS to access the latest treatments and adaptive strategies. Advancements in tremor management can help many individuals achieve good control over their symptoms.
Can MS hand tremors be prevented?
There is no known way to prevent the development of MS tremors since they are caused by the underlying disease process of multiple sclerosis. However, managing MS through early treatment may help slow the progression of symptoms like tremors.
Steps that may help reduce the impact of tremors include:
- Taking MS medications as prescribed to minimize disease activity.
- Staying hydrated and keeping cool to avoid heat exacerbations.
- Getting adequate rest and avoiding fatigue.
- Undergoing occupational therapy to learn adaptive techniques.
- Using assistive devices to maintain stability.
- Practicing stress management.
- Quitting smoking and minimizing alcohol intake.
While these steps cannot always prevent tremors if MS lesions affect motor control pathways, they can still make a difference in minimizing symptoms.
What is the link between MS and Essential Tremor?
Essential tremor and MS tremors are two distinct movement disorders:
- Essential tremor is a progressive neurological condition that causes involuntary shaking, usually of the hands and arms. It is one of the most common movement disorders.
- MS tremor occurs as a symptom of multiple sclerosis. It is caused by damage to the central nervous system from MS lesions rather than being an isolated condition.
While essential tremor and MS tremors share some similarities, there are some differences:
Essential Tremor | MS Tremor |
---|---|
Typically involves a postural tremor | Often includes an intention tremor |
Gets worse with age | Variable progression |
Runs in families in at least 50% of cases | Not hereditary |
In some cases, people may have both essential tremor and MS tremors concurrently. The conditions are not directly linked – one does not cause the other. However, having both conditions at once can exacerbate tremors.
Can stress and anxiety make MS tremors worse?
Yes, stress and anxiety can often exacerbate MS-related tremors. During times of stress, the body releases hormones like adrenaline and cortisol. These stress hormones increase metabolism, elevate heart rate, and prepare the body for the “fight or flight” response.
In people with MS, high levels of stress hormones may:
- Increase nerve signaling issues and sensory symptoms
- Worsen immune system overactivity
- Amplify fatigue
- Disrupt coordination and trigger tremors
Managing stress through relaxation techniques, exercise, social support, therapy, or medications can help minimize flare-ups of MS symptoms. Lowering stress and anxiety levels allows the body to maintain a healthier neurological balance.
Tips for managing stress to reduce MS tremors
- Practice calming activities like yoga, deep breathing, or meditation
- Exercise regularly
- Get enough restful sleep
- Maintain a healthy diet
- Join a support group
- Try massage or acupuncture treatments
- Talk to a counselor or therapist
- Listen to relaxing music
- Take time for hobbies and social activities
What tests help differentiate MS tremors from other neurological conditions?
Some key tests that can help differentiate MS tremors from conditions like Parkinson’s disease, essential tremor, or cerebellar tremor include:
- Neurological exam – Assesses the pattern and type of tremors present.
- Brain MRI – Detects MS lesions and atrophy.
- Blood tests – Helps rule out metabolic causes like thyroid dysfunction.
- EMG/nerve conduction studies – Evaluates electrical signaling in nerves and muscles.
- PET scan – Measures brain metabolism to distinguish Parkinson’s.
- Genetic testing – Identifies gene mutations linked to essential tremor.
MS has some characteristic features on neurological exam like intention tremor and internuclear ophthalmoplegia. The location and appearance of lesions on an MRI can also point to MS as the cause. No single test definitively distinguishes all the potential tremor disorders, so doctors synthesize results from various tests.
Are there any alternative treatments for MS tremors?
Some alternative therapies that may help manage MS hand tremors include:
- CBD oil – May have anti-inflammatory and neuroprotective effects to reduce tremors.
- Vitamin D – Helps regulate calcium channels involved in nerve conduction.
- CoQ10 – Antioxidant that supports nerve cell energy metabolism.
- Omega-3 fatty acids – Anti-inflammatory effects to protect myelin and nerves.
- Acupuncture – May relieve tremors by stimulating nerves.
- Magnets – Applying small magnets near nerves may reduce tremor severity.
Mind-body practices like yoga, tai chi, meditation, biofeedback, and hypnotherapy may also minimize tremors through relaxation. However, more research is needed on these alternative therapies for MS tremors specifically.
Always check with your healthcare provider before using supplements, vitamins, or unconventional treatments to avoid interactions with MS medications.
Tips when considering alternative MS tremor treatments
- Look for well-designed research studies supporting efficacy and safety
- Use trusted brands of supplements from reputable sources
- Start alternative therapies one at a time
- Keep your neurologist informed of any over-the-counter treatments
- Monitor for side effects or reactions
- Make sure the provider is experienced treating MS patients
Conclusion
MS tremors are common neurologic symptoms resulting from damage to the central nervous system from multiple sclerosis. Intention and postural tremors of the hands and arms are most typical. Medications, therapy, assistive devices, and lifestyle changes can help reduce the impact of MS tremors on daily functioning. While tremors cannot be cured, ongoing management can often minimize their severity. With the right treatment approach, most people with MS tremors can find ways to successfully adapt and control their symptoms.