Managing Tremor in Multiple Sclerosis | MS Association of America
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Home > About MS > What are the Symptoms of MS? > Tremor
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Tremor is an involuntary, rhythmic shaking movement of the muscles. It is most commonly due to the loss of myelin on axons in the central nervous system pathways that coordinate muscle movement and balance. It can affect many parts of the body, and is one of the most frustrating symptoms of MS.

Rehabilitation Strategies

Physical or occupational therapists may be able to reduce the effects of tremor by teaching specific positions for some activities or by balance and coordination exercises. These might include patterning, which involves repeating a series of movements related to an activity such as eating, until those movements essentially become automatic and can be performed without accompanying tremor. Rehabilitation therapists may also teach exercises that focus on stimulating the balance centers of the brain.

Weighting involves using utensils and other devices that are modified so that the extra weight helps to stabilize arm tremors.

Pharmacologic Management

Atarax®, Vistaril®(hydroxyzine)

These oral antihistamines may be useful for minor tremors that are made worse by stress.

Klonopin® (clonazepam) and Buspar®(buspirone)

These are oral medications originally developed as anti-anxiety agents. Clonazepam may help tremor by causing sedation. Buspirone primarily is not a sedating or habit-forming drug. At a dose of 5 to 10 mg, three to four times daily, buspirone may help with tremor and is well tolerated.

Side effects include oversedation (with clonazepam).


Please refer to the spasticity section for details on this oral medication.


This oral medication is a beta-blocker, originally developed as a medication to regulate heart rate. The initial dose is 80 mg, and it is increased slowly until an effective dose is reached.

It provides modest relief for some tremor.

Side effects include abnormal heartbeats, lightheadedness, gastrointestinal symptoms, and confusion.


This is an oral medication originally developed as an anti-nausea drug for use with cancer chemotherapy. The usual dose is 4 to 8 mg, taken 3 to 4 times per day, and may produce a decrease in tremor in some patients. This medication has few side effects.


This is an oral medication in tablet form. It was originally developed as an anti-seizure medication. Small Italian and British pilot studies were encouraging, but more research is needed. For more information, please see the spasticity section.

Side effects include sedation, weakness, and dizziness.


This oral medication was developed as an anti-seizure drug. It has some anti-tremor effects when used in lower doses than those prescribed for epilepsy. The initial dose is 50 mg, which is increased gradually.

Side effects include significant sedation.

Laniazid®, Nydrazid®(isoniazid)

This oral medication was developed to treat or prevent tuberculosis. It is effective for certain types of tremor; its mechanism of action is unknown.

Side effects may include nervousness, sleep difficulties, headache, and nausea.

Surgical Management

Thalamotomy and Deep Brain Stimulation

Because tremor results from damage to axons in an area of the brain called the "thalamus," it is sometimes treated surgically. One technique, known as a thalamotomy, destroys a section of the thalamus. Another technique, deep brain stimulation, was originally developed to treat the tremor associated with Parkinson's disease. Instead of destroying the area of the thalamus that causes tremor, an electrode is implanted in the region, and connects a wire lead to a control device implanted under the skin. Activating the device sends impulses into the thalamus, disrupting the signals that cause tremor.

Last Updated on Wednesday, 16 October 2013 13:13