WebMD Medical News
Louise Chang, MD
July 3, 2012 -- Many people with multiple sclerosis (MS) will develop a tremor, and until now, there was little that could be done to minimize this shaking.
Now new research shows that shots of Botox, the very same wrinkle-busting injection that helps frown lines, may ease hand and arm tremors.
The findings appear in Neurology.
MS is an autoimmune disease that occurs when the body misfires against the myelin, a fatty substance that insulates the nerve fibers of the brain, spinal cord, and optic nerves (central nervous system). Approximately 400,000 people in the U.S. have MS. Jack Osbourne, a reality TV star and son of Sharon and Ozzy, recently revealed that he has MS.
Symptoms range from mild numbness in the limbs to paralysis or loss of vision. Tremors may occur in the arms, legs, head, body, or muscles needed for speaking and/or sex. They are caused by the destruction of myelin in the nerves that are responsible for voluntary movements.
Botox is FDA-approved for use in treating crossed eyes, muscle spasms, excessive sweating, migraine headaches, and loss of bladder control due to MS. It is also being investigated in a host of other diseases and conditions, including osteoarthritis.
In the study, 23 people with MS were given Botox injections or inactive shots in their affected arm. Three months later, they received the opposite treatment. Researchers measured the tremor severity and their ability to write and draw before and after the injections. They also took videos of the participants performing these tasks.
The Botox seemed to make a difference.
People showed improvement in tremor severity, writing, and drawing at six weeks and three months after the Botox shots, the study shows.
Tremor severity improved by about two points on a 10-point scale, which took a tremor from the moderate range to a milder one. Participants improved by an average of one point on a 10-point scale in writing and drawing tasks.
Muscle weakness developed in 42% of people after Botox injections, compared to 6% of those who received the inactive shot. This weakness was generally mild and went away within two weeks.
When people think of MS, they don't think about shaking or tremors, says Nicholas LaRocca, PhD. He is the vice president of health care delivery and policy research at the National MS Society in New York City. "They usually think about difficulty walking, but tremors affect the majority of people with MS."
They may not always be visible, as these "intention" tremors occur when a person reaches for something. Tremors tend to be more common as the disease progresses.
There is no cure for MS tremors, but they may be treated with:
"But we really do not have an effective treatment, so Botox could be a significant advance," he says. "Time will tell, but this is a promising study that looked at tremor from many different angles and was able to show that there was benefit."
The next step is a larger study, LaRocca says. It is important to make sure that the minor muscle weakness seen in this study does not become a major problem down the road.
If you or someone you love has an MS-related tremor, "talk with a specialist who has experience in treating people with MS about the current options for tremors," he says.
Gayatri Devi, MD, says she is ready, willing, and able to try this treatment in patients with an MS tremor today. She is a neurologist at Lenox Hill Hospital in N.Y.
"I think it is a grand idea," she says. Botox is already used for other types of tremors, so this is not a big stretch. She often uses Botox to treat overactive bladders in people with MS.
Devi is not overly concerned about the muscle weakness side effect seen in the new study. "The tremor is so disabling and crippling that it's a little bit of trade-off."
SOURCES:Nicholas LaRocca, PhD, vice president of healthcare delivery and policy research, National MS Society, New York City.Gayatri Devi, MD, neurologist, Lenox Hill Hospital, New York City.Van Der Walt, A. Neurology, 2012.
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