Q :   Is there any treatment for tremor?
A :   Tremor is a very difficult problem to treat. One treatment that has essentially no side effects is the use of a weight on an extremity to increase its mass, and thus reduce the extent of the tremor. For example, a five-pound weight can be strapped to the wrist to assist in eating or self-care. Several medications also have been reported to help and can be tried, such as propranolol or isoniazid. Our experience with these drugs has generally been disappointing.

Q :   What exercises can be done to decrease leg tremor when standing?
A :   Shaking of a person"s legs may be due to spasticity, ataxia, or muscle weakness. Management depends on which of these problems is causing the symptom. Stretching a tight muscle can help reduce the stretch reflex in a spastic muscle, as well as allowing better joint position. Consequently less muscle energy is required to stand, and leg shaking may be reduced. Pharmacologic treatment is almost always also indicated, with baclofen generally the most effective medication. Too much should be avoided, as that might produce additional weakness. (Small amounts of spasticity may actually enhance standing in weak muscles.) If the problem is ataxia, ankle weights may also reduce shaking, much in the same way that wrist weights can reduce upper limb ataxia.

Q :   What can be done about the lumps or bumps in muscle fibers associated with muscle spasms?
A :   MS can produce spasms in muscles, but in general the whole muscle becomes tight and reflexes become exaggerated. There is a condition known as myofascial pain or fibrositis that causes muscle pain. This can cause "lumps" in muscles so that they feel like ropes when rubbed or palpated. There is no laboratory test to diagnosis fibrositis. Lumps and bumps in muscles are more likely to be related to fibrositic problems than to MS.

Q :   What are the current recommendations for nighttime muscle spasms?
A :   Spasms can be related to MS or may be simple muscle cramps identical to those that occur in people without MS. Multiple sclerosis can increase spasticity in muscles, and certain positions in bed can trigger this spasticity. There are two approaches to management. One is to stretch the affected muscle before bedtime so that the stretch reflex of that muscle will not be set off by a small amount of movement. The second is to use a pharmacologic agent such as baclofen to treat spasticity. A combination of stretching exercises, physical therapy, and pharmacologic intervention may be necessary to control night-time muscle spasms.

Q :   What nonpharmacologic strategies can be used to deal with painful spasms?
A :   Physical medicine interventions are the best strategies for alleviating painful muscle spasms. Stretching and other exercises can help ameliorate these symptoms. Physicians who specialize in physical medicine and rehabilitation (physiatrists) and physical therapists can assess the problem and prescribe strategies specific to each individual.

Q :   What can you tell us about myoclonic jerks?
A :   Myoclonic jerks and twitches commonly occur as an individual falls asleep and do not need intervention. If these jerks become a serious problem, drugs used to treat myoclonic epilepsy can be tried. A neurologist or physiatrist can accurately diagnose the problem and prescribe pharmacologic intervention.

Q :   What medications are used to treat spasms in MS?
A :   Oral baclofen is the initial drug of choice for the pharmacologic treatment of spasticity in MS. Side effects of this medication can be drowsiness and fatigue. Nausea is also possible but can be avoided by taking the medication with food. Some patients, however, benefit from high doses of baclofen but have too many side effects. If spasticity is primarily limited to the lower limbs, a small catheter can be placed in the spinal canal and connected to a small implanted pump that administers baclofen directly to the spinal cord. This form of baclofen administration is very effective for those patients whose spasticity is in the lower limbs and who cannot take oral baclofen. Other drugs that may also be used for spasticity include dantrolene sodium and diazepam. Some patients benefit from a regimen of combination therapy.

Q :   Are new anti-inflammatory drugs helpful for muscle spasms?
A :   Anti-inflammatory drugs are not effective for muscle spasms. These drugs, which include aspirin, corticosteroids, and nonsteroidal anti-inflammatories (NSAIDs) are used to treat inflammation of tissue such as occurs in arthritis.

Nancy Holland, T. Jock Murray, and Stephen C. Reingold
Living with Multiple Sclerosis - A wellness approach, By: George H. Kraft, MD and Marci Catanzaro, RN, PhD, 1996, New York: Demos, pp22-24. ISBN: 1 888 799 00 5
Reproduced with kind permission from Demos Medical Publishing
Available from Demos Medical Publishing, 386 Park Avenue South, Suite 201, New York, NY 10016, USA. Tel +(212) 683 0072. Fax: +(212) 683 0118. Web site: www.demosmedpub.com or by e-mail to orderdept@demospub.com