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When a person with Down syndrome has vitamin B12 and/or folate deficiency, the increase in the homocysteine level may not be great enough to overcome this starting low value of homocysteine

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MRI may show cerebral white matter atrophy, ventricular enlargement, periventricular gliosis, optic nerve atrophy, delayed myelin formation or dysplasia, cerebellar hypoplasia, cerebellar hemisphere atrophy, and hypersignal in the subcortical white matter [116, 117]

Lab testing may be recommended, but its not always required to begin treatment

Often by changing the overall biomechanics of the trunk and lower extremities the piriformis muscle is relieved of excess strain and your pain eases