Nancy Holland, T. Jock Murray, and Stephen C. Reingold

Everyone has some tremor (to see the normal physiologic tremor put a piece of paper on top of your outstretched hand). Multiple sclerosis may be accompanied by different types of tremor, which range from annoying to fairly disabling. There are a variety of approaches to controlling them, some of which people learn on their own. For instance, bracing the forearm against the side or on a hard surface reduces arm and hand tremor. Another variation is to have a method of immobilization that is used for some specific task such as writing, but is removed when the task is over. Physical and occupational therapists may use patterning, repeating movements to make them smoother and more automatic. Adding weights to the limb may reduce tremor. There is also adaptive equipment that can be useful.

Medication is only partially effective, and some of the drugs tried in the past seemed to give limited assistance and caused side effects. Perhaps the only drugs that may have a significant effect are beta blockers such as propranolol (Inderal®). Mild sedatives and tranquilizers may help, but they are probably only worthwhile when the person has some other need for a sedative, such as tension or anxiety, which aggravate tremor. Stereotactic surgery may be used in selected cases, but this is unusual and carries significant risk.