Vitamin B-12 Associated Neurological Diseases Medication: Dietary supplements

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Vitamin B-12 Associated Neurological Diseases

Sections Vitamin B-12 Associated Neurological Diseases
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Medication

Medication Summary

Standard treatment in patients with vitamin B-12 deficiency consists of parenteral or oral cobalamin. The hematologic abnormalities may respond to folate, but the neurologic manifestations only respond to cobalamin.

Numerous treatment regimens have been proposed, including cobalamin 1000 mcg IM/SC daily for 5 days followed by 1000 mcg/wk for 5 weeks, then 100-1000 mcg/mo for life.

Because 1% of cobalamin is absorbed by passive diffusion, administration of large oral doses is an alternative; 1000 mcg daily yields a daily absorption of 10 mcg, which exceeds the 2-mcg recommended daily allowance (RDA) requirement.

In addition to cobalamin replacement, oral IF supplementation is being evaluated. Supplementation with SAM or methionine-rich diets are being studied for N₂O-induced myeloneuropathies.

Diagnosis and treatment of tapeworm infection and celiac and Crohn diseases can improve intestinal vitamin B-12 malabsorption. With blind loop syndrome, tetracycline can normalize the intestinal flora and vitamin B-12 absorption.

Class Summary

Cyanocobalamin is used to replenish the deficiency caused by any of the etiologies described.

Cyanocobalamin (Berubigen, Cyanoject)

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Most stable and available form of vitamin B-12. Absorbed rapidly to the organism from IM or SC applications.

Oral cyanocobalamin can replace parenteral formulations. Is effective in PA because 1% of free cobalamin is absorbed via diffusion rather than requiring the presence of IF.

Folic acid (Folvite)

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Folate supplementation can reverse the hematologic abnormalities, but the neurologic manifestations only respond to cobalamin.

Questions

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Media Gallery

Vitamin B-12–associated neurological diseases. Cobalamin and folate metabolism. TS = thymidylate synthase, DHFR = dihydrofolate reductase, SHMT = serine methyl-transferase.
Vitamin B-12–associated neurological diseases. Cobalamin deficiency leads to reduced adenosylcobalamin, which is required for production of succinyl-CoA. D-methylmalonyl-CoA is converted to methylmalonic acid.
Vitamin B-12–associated neurological diseases. Pernicious anemia. Characteristic lemon-yellow pallor with raw beef tongue lacking filiform papillae. Photo from Forbes and Jackson with permission.
Vitamin B-12–associated neurological diseases. Fluid attenuated inversion recovery (Flair) MRI sequence in a patient with cobalamin deficiency and neuropsychiatric manifestations. Discrete areas of hyperintensities are present in the corona radiata.

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Author

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Coauthor(s)

Florian P Thomas, MD, PhD, MA, MS Chair, Neuroscience Institute and Department of Neurology, Director, Hereditary Neuropathy Center, Co-Director, Center for Memory Loss and Brain Health, Co-Director, ALS Center, Hackensack University Medical Center; Associate Dean of Faculty, Founding Chair and Professor, Department of Neurology, Hackensack Meridian School of Medicine

Florian P Thomas, MD, PhD, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Alan L Diamond, DO Movement Disorder Fellow, Department of Neurology, Baylor College of Medicine

Alan L Diamond, DO is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Osteopathic Association, American Society of Neuroimaging

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Nestor Galvez-Jimenez, MD, MSc, MHA The Pauline M Braathen Endowed Chair in Neurology, Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, International Parkinson and Movement Disorder Society

Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Bioserenity, Catalyst, Ceribell, Eisai, Jazz, LivaNova, Neurelis, Neuropace, SK Life Science Science, Sunovion, Takeda, UCB<br/>Serve(d) as a speaker or a member of a speakers bureau for: Catalyst, Jazz, LivaNova, Neurelis, SK Life Science, Stratus, UCB<br/>Received research grant from: Cerevel Therapeutics; Ovid Therapeutics; Neuropace; Jazz; SK Life Science, Xenon Pharmaceuticals, UCB, Marinus, Longboard.

Additional Contributors

Christopher Luzzio, MD Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health

Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Sections Vitamin B-12 Associated Neurological Diseases
Overview
Presentation
- History
- Physical
- Causes
- Complications
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DDx
Workup
Treatment
Medication
Questions & Answers
Media Gallery
References

Vitamin B-12 Associated Neurological Diseases Medication

Medication Summary

Dietary supplements

Class Summary

Cyanocobalamin (Berubigen, Cyanoject)

Cyanocobalamin (Berubigen, Cyanoject)

Folic acid (Folvite)

Folic acid (Folvite)

References

Tables

Contributor Information and Disclosures

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