Course and progression

Untreated, the disorder is progressive, the patient eventually becoming bed-bound and comatose. If diagnosed and treated early (within 2 months of onset), complete recovery can be anticipated. In established cases, only progression may be halted.

Caution:

When folic acid is prescribed for megaloblastic anaemia, it will improve the haematological picture of B12 deficiency but causes rapid and occasionally irreversible deterioration of the neurological symptoms and signs.

Calciferol (vit. D)

This vitamin is involved in muscle metabolism. Deficiency results in fatigue, muscle weakness and atrophy. These neurological features are associated with hypocalcaemia and osteomalacia.

Tocopherol (vit. E).

In its active form -Da tocopherol - it acts as a membrane stabilizer and anti-oxidant. Deficiency occurs in chronic fat malabsorption (e.g. coeliac disease or cystic fibrosis) and results in widespread neurological disturbances -ataxia, ophthalmoplegia, seizures and corticospinal tract dysfunction. These are halted and often reversed by i.m. vit. E. It has been speculated that the antioxidant effect might make vitamin E a candidate for cytoprotection and repair within the nervous system. Studies in Parkinson's disease, multiple sclerosis and stroke are disappointing.

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