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No 1131517
Multiple Sclerosis
It is important to remember that MS is only one part of a person and not the person.
MS does not represent them, it is not their identity, they are as normal as the next person.
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Tremor
An involuntary, rhythmical, alternating movement that can affect the muscles of any part of the body.
Tremor varies in speed, severity, location, and duration and may come and go affecting the limbs, trunk, head, voice and speech. Tremor may be irritating, or can be extremely disabling depending on its severity.
Different areas of the body may experience tremor while at rest, or may shake only when a purposeful movement is made. Backwards and forwards motion may be observed with gross tremor, while others may experience fine tremor, where shaking is barely visible and so mild it is not obvious to others.
Tremor can become more pronounced, causing drink to spill or difficulty holding and guiding a knife, fork and spoon when eating, it can also affect handwriting. In a few, tremors can be very severe, causing limbs and the body to shake making it difficult or even impossible to eat, drink, or get dressed without help. Tremor may become gradually noticeable or develop quite swiftly.
For some tremor can develop during relapses which will often lessen when the relapse is over, however, some level of tremor may remain after a relapse. Even with almost complete recovery, it sometimes remains noticeable.
The exact cause of tremor is unknown, it is considered to be due to lesions in the cerebellum, the area of the brain responsible for balance, coordination and a ‘fluidity’ of movements of limbs, speech and eyes. Tremor may also be the result of demyelination in other parts of the brain such as the thalamus and the basal ganglia.
Intention Tremor
Is
characterised by a slow, broad shaking that occurs at the end of an intended movement,
it is most noticeably in the hands. It is also known as Kinetic, Action and Cerebella
Tremor.
Intention Tremor is more obvious when performing delicate fine movements than broad sweeping ones.
Intention Tremor is detected by neurologists using finger to nose tests. The neurologist holds up his or her finger and you move your finger from your nose to his or her finger and back to your nose.
Some experience jaw, lip, or tongue tremor which may affect their ability to speak efficiently while postural tremors occur when the limbs are outstretched.
Fatigue and heat can make tremors worse.
Management
Medication -
- Clonazepam This drug can cause tolerance and dependency and dosage should be monitored.
- Propranolol -
Inderal is a beta blocker it is usually effective in treating only physiologic tremors. - Amantadine -
Symmetrel helps to reduce shaking for some individuals. This medication also has antiviral properties and is sometimes prescribed to alleviate fatigue. - Baclofen -
Lioresal is a drug often taken by people with MS to treat spasticity. It also helps to slow tremor, the drug may produce weakness as a side effect. - Tremor responds minimally to steroid treatment.
- Orthopaedic Equipment
- Physiotherapy
- Thalamotomy and Thalamic Stimulation
A surgical technique used to treat serious intention tremor in MS. It is sometimes
also known as stereotactic deep brain stimulation -
Deep brain stimulation involves electrodes permanently implanted in selected parts of the brain. A battery is implanted near the collarbone and is connected by a thin wire and which sends pulsed messages to the electrodes. These block nerve impulses that are believed to cause tremor.
A recent review found that deep brain stimulation was successful in restoring functional ability in around 85% of people who underwent the procedure. However, the procedure itself carries some risks.
A small number of people experience a brain haemorrhage during the implantation, and there is the risk of developing significant new symptoms particularly speech and swallowing, and balance disorders.
There have been few studies of the long-
One study followed five people with MS over five years following treatment for intention tremor in their arms. It found that the tremor was effectively suppressed over this period, however, their arms became progressively weaker over time. This weakness and loss of function persisted in two people even after the electrodes had been switched off.
Deep brain stimulation tends to be viewed as an option only for significantly disabling tremor. It is available at some specialised neurosurgical units in the UK. [1]
1. Yap L, et al. Stereotactic neurosurgery for disabling tremor in multiple sclerosis:
thalamotomy or deep brain stimulation? British Journal of Neurosurgery 2007;21(4):349-
2. Hyam JA, et al. Post-