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What Causes Upper Body Tremors And Memory Problem In A Patient With MS?
Question: my wife is age 61, has MS (about 25 yrs now), mobility issues for 15 yrs (legs, back) takes baclofen, tizanidine and lyrica (for nighttime leg spasms). She recently has been experiencing upper body tremors, short-term memory problems, confusion, fatigue, especially in the morning. Could this be a drug interaction or underlying health issue. So hard to tell with MS - good days and bad days......
Additional info - concerns elevated when couldn't raise arms, grasp anything or sit up upon rising yesterday morning on waking at 8 AM. But by 10 AM or so symptoms had decreased to normal MS difficulties, although still some confusion, memory loss, tremors. But she could sit up, raise arms, grasp things. Severity did not increase until next morning on waking, although not as severe as previous morning.
Additional info - concerns elevated when couldn't raise arms, grasp anything or sit up upon rising yesterday morning on waking at 8 AM. But by 10 AM or so symptoms had decreased to normal MS difficulties, although still some confusion, memory loss, tremors. But she could sit up, raise arms, grasp things. Severity did not increase until next morning on waking, although not as severe as previous morning.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
As you say it is hard to tell with MS especially in long standing patients. That is because even if there might have been no visible relapses, it has been shown that the brain of MS patients does undergo changes over time, there is brain atrophy, shrinking of the brain due to loss of brain mass. Such loss of brain cells happens in all of us, but in MS patients it is more accelerated, so in someone diagnosed since 25 years it may be really advanced. As a result deterioration of higher mental functions like memory, judgement, speech etc may appear and justify in a way your memory and confusion problems.
However one must be careful before attributing all changes to that, especially if changes have developed in a sudden manner. That is because a MS patient is not immune to conditions affecting other organs. In particular MS patients are vulnerable to infections, commonly urinary infections which may not manifest marked urinary symptoms but may lead to a deterioration of the neurological status similar to the one you describe. Also damage to liver, kidney or any other metabolic change affect a MS patient more severely than others. So these conditions should be searched as they may be treatable and can return to baseline.
So an evaluation is necessary, both a general physical exam by your primary physician as well as some routine blood tests such as blood count, inflammation markers (PCR, ESR), urine analysis, blood glucose, liver and kidney function, electrolytes.
If tests reveal no abnormalities then the possibility of MS being the cause is likely, perhaps a control MRI should be scheduled if you haven't had one recently.
Drug side effects are also a possibility, especially if the deterioration has appeared after adding a new drug, all the medication you mentioned may have side effects including confusion and fatigue, so if no other cause is found reducing medication may be tried.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
As you say it is hard to tell with MS especially in long standing patients. That is because even if there might have been no visible relapses, it has been shown that the brain of MS patients does undergo changes over time, there is brain atrophy, shrinking of the brain due to loss of brain mass. Such loss of brain cells happens in all of us, but in MS patients it is more accelerated, so in someone diagnosed since 25 years it may be really advanced. As a result deterioration of higher mental functions like memory, judgement, speech etc may appear and justify in a way your memory and confusion problems.
However one must be careful before attributing all changes to that, especially if changes have developed in a sudden manner. That is because a MS patient is not immune to conditions affecting other organs. In particular MS patients are vulnerable to infections, commonly urinary infections which may not manifest marked urinary symptoms but may lead to a deterioration of the neurological status similar to the one you describe. Also damage to liver, kidney or any other metabolic change affect a MS patient more severely than others. So these conditions should be searched as they may be treatable and can return to baseline.
So an evaluation is necessary, both a general physical exam by your primary physician as well as some routine blood tests such as blood count, inflammation markers (PCR, ESR), urine analysis, blood glucose, liver and kidney function, electrolytes.
If tests reveal no abnormalities then the possibility of MS being the cause is likely, perhaps a control MRI should be scheduled if you haven't had one recently.
Drug side effects are also a possibility, especially if the deterioration has appeared after adding a new drug, all the medication you mentioned may have side effects including confusion and fatigue, so if no other cause is found reducing medication may be tried.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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