Tremors in People with Down Syndrome

Key Points

• Tremors are repetitive involuntary movements.

• Tremors can be mild and cause limited disruption or more severe and restricting.

• There are many causes for tremors. An evaluation by a health professional can determine the cause and appropriate treatment.

• There are several lifestyle changes and techniques that can be implemented to reduce a tremor and/or help with limiting the negative effect of a tremor.

• Tremors do not seem to be more common in people with Down syndrome.

What are tremors?

A tremor is an involuntary (not done purposefully) repetitive movement of a body part. It typically occurs with pretty consistent frequency and amplitude (amount of movement). Tremors are often classified as rest tremors (occurring at rest or when not actively moving the body part) or action tremors (occurring when voluntarily moving the body part).

Tremors may be mild and cause minimal disruption or may be more severe and impede the ability to do daily activities and/or occupational activities.

In our experience, tremors are not more common in people with Down syndrome. Tremors are not typically described as a feature or symptom associated with Down syndrome. There is limited information/research available about tremors in people with Down syndrome.

Diagnosis

Depending on the cause and severity, the diagnosis and treatment of a tremor may be done by a primary care provider, a neurologist, and/or a movement disorder specialist (a neurologist that specializes in movement disorders).

The evaluation for a tremor by a health professional may include:

• A history and physical exam to assess whether it occurs at rest or with action of the body part, where it is located, and how much impact on the individual's life it is causing.

• Assessment to rule out other types of movement conditions.

• Possibly blood work (labs).

• Possibly imaging (CT, MRI) of the nervous system (brain and/or spinal cord).

• An EEG if seizures are thought to be a possible cause of the abnormal movement.

What causes tremors?

Some of the causes of tremors include:

Caffeine

Some medications

Examples include valproic acid (used for seizures and sometimes for mental health conditions), some asthma medications (bronchodilators), some anti-psychotic medications, and others. 

Stopping the medication will usually result in the stopping of the tremor but it may take months in some cases. This Healthline article on drug-induced tremors  provides additional information.

Hyperthyroid

Benign essential tremor or essential tremor

Benign essential tremors  are considered "benign" because they do not shorten life expectancy, but they can cause significant disability, embarrassment, and potentially limitations on activities required for daily living or job performance.

Hypoglycemia

Neurological conditions

Anxiety

Insufficient sleep

Insufficient sleep can cause tremors. Several sleep issues, including sleep apnea, are more common in people with Down syndrome. Information is available in the Sleep section of our Resource Library.

It is important to consider other conditions that can cause abnormal or unusual movements that are not tremors. 

• Stereotypies

• Tics (including Tourette's syndrome)

• Seizures

In our experience, we do not see a lot of individuals with Down syndrome with tremors. When we do see an individual with Down syndrome with a tremor, some of the common reasons in younger individuals include medication side effects, overactive thyroid, benign essential tremor, caffeine, anxiety, and insufficient sleep. In older individuals with Down syndrome, we do see some individuals with dementia who develop tremors.

Treatment

Depending on the severity of the tremor, its impact on the person’s life, and the cause, it may not be necessary to treat a tremor.  If treatment is needed, it will depend on the cause of the tremor. The National Institute of Neurological Disorders and Stroke  provides more information on diagnosis and treatment depending on the cause. In addition, their website includes a nice summary of lifestyle changes that can help with a tremor:

"Certain lifestyle changes and techniques may provide some relief for mild to moderate tremor.

• Physical, speech, and occupational therapy may help control tremor and adapt to daily challenges caused by the tremor.

• Eliminating or reducing caffeine.

• Assistive tools such as special plates, spoons, or heavier utensils can lessen tremor and make it easier to eat.

• Take medications on time. Talk with a doctor about stopping any medications that may be contributing to the tremor.

• Reduce stress or stressful situations that can aggravate the tremor.

• Wear clothes that make it easier to dress, such as those that use Velcro instead of buttons. Consider slip-on or no-tie shoes.

• Get enough sleep. Some tremors worsen when a person is tired. Physical activity and exercise can help prevent fatigue and improve sleep."