Photo: close up of microscope

Causes and effects of tremor

In MS, there is damage to the protective material – called ‘myelin’ – around the nerves in the brain and the spinal cord. When myelin is damaged – known as ‘demyelination’ – messages get slower or distorted or do not get through at all, causing the symptoms of MS.

What causes tremor?

MS tremors are usually caused by damage to myelin in an area of the brain known as the ‘cerebellum’, and the nerves leading to and from it. The cerebellum is the part of the brain that controls your balance and coordination. It ‘smoothes out’ the movement of your limbs, eyes and speech. Tremor can also be the result of demyelination in other areas of the brain – including the thalamus and the basal ganglia, which are both involved in controlling movement.

Like other MS symptoms, tremor can come and go, or it could be progressive. If you experience tremor as the result of a relapse, you might find that you are still left with some level of tremor once the relapse is over.

Other reasons for tremor

If you have intention or postural tremor because of your MS, you will probably find that while your muscles are completely relaxed – such as when you are lying down or asleep – your tremor goes away. If it doesn’t, there may be another reason for it.

Tremor can be the result of muscle weakness and problems with posture, or a side effect of some medications (such as drugs for asthma). It could also be caused by other neurological conditions, such as Parkinson’s.

The effects of tremor

For some people, their tremor is so mild they’re the only person aware of it. For others, it’s more obvious. It might be difficult to carry a drink without spilling it, or to hold a pen steady to write. For a few people, it can be so severe that everyday activities like eating, drinking or getting dressed are difficult or impossible without help.

Getting help and support

If your tremor is severe, it can have a significant impact on your independence. It can also directly affect your general well-being, work and social life. You might feel embarrassed about your tremor, and may be avoiding situations which make you feel self-conscious about it. Or it might make you feel anxious, and that anxiety may be making your tremor worse.

Whatever you feel – and it may be different at different times – you don’t have to cope alone. You might find that talking to other people with tremor helps. Your MS nurse, for example, may know about any support groups in your area and may be able to find further support for you and your family. Your local branch of the MS Society may also be able to offer support as well as other activities.

If you think that counselling might help, you can ask your GP or MS nurse for a referral. This may be particularly helpful if anxiety is making your tremor worse. Bear in mind, though, that the availability of counselling on the NHS is quite limited, so you may have to wait a while and may only get a certain number of appointments. You can also ask your GP to recommend a private counsellor, or if counselling is available from any voluntary organisations in your area. Many MS National Therapy Centres offer counselling services.

> Read more about treating and managing tremor

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