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Biologically Significant Serum Vitamin B12 Deficiency in Multiple Sclerosis Inadequately Documented

Biologically Significant Serum Vitamin B12 Deficiency in Multiple Sclerosis Inadequately Documented Abstract To the Editor. —The recent article by Reynolds et al1 on potential association of vitamin B12 "deficiency" and multiple sclerosis (MS) is of considerable interest to patients with MS and physicians involved in their care. The significance of this observation, however, remains unclear because convincing evidence of a vitamin B12deficiency in patients with MS was not documented by the authors. Although the serum vitamin B12 assay is an extremely sensitive test for a vitamin B12 deficiency, it lacks specificity. It has been established that many patients with low serum B12 levels do not have a documentable cobalamin deficiency state. The currently available confirmatory tests for biologically significant vitamin B12 deficiency include determination of serum methylmalonate and homocysteine levels, which have been shown to be elevated in the vast majority of vitamin B12—deficient patients with objective hematologic or neuropsychiatric changes attributable References 1. Reynolds EH, Linnell JC, Faludy JE. Multiple sclerosis associated with vitamin B12 deficiency . Arch Neurol . 1991;48:808-811.Crossref 2. Stabler SP, Allen RH, Savage DG, Lindenbaum J. Clinical spectrum and diagnosis of cobalamin deficiency . Blood . 1990;76:871-881. 3. Allen RH, Stabler SP, Savage DG, Lindenbaum J. Diagnosis of cobalamin deficiency, I: usefulness of serum methylmalonic acid and total homocysteine concentrations . Am J Hematol . 1990;34:90-98.Crossref 4. Green R, Gatautis V, Jacobsen DW. Serum methylmalonic acid (MMA) and homocysteine (HCY) are more specific tests than serum vitamin B12 for identifying true cobalamin (cbl) deficiency . Blood . 1990;76( (suppl 1) ):33A. 5. Ransohoff RM, Jacobsen DW, Green R. Vitamin B12 deficiency and multiple sclerosis . Lancet . 1990;335:1285-1286.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Biologically Significant Serum Vitamin B12 Deficiency in Multiple Sclerosis Inadequately Documented

Biologically Significant Serum Vitamin B12 Deficiency in Multiple Sclerosis Inadequately Documented

Abstract

Abstract To the Editor. —The recent article by Reynolds et al1 on potential association of vitamin B12 "deficiency" and multiple sclerosis (MS) is of considerable interest to patients with MS and physicians involved in their care. The significance of this observation, however, remains unclear because convincing evidence of a vitamin B12deficiency in patients with MS was not documented by the authors. Although the serum vitamin B12 assay is an extremely sensitive test for a...
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References (7)

Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1992.00530310021005
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor. —The recent article by Reynolds et al1 on potential association of vitamin B12 "deficiency" and multiple sclerosis (MS) is of considerable interest to patients with MS and physicians involved in their care. The significance of this observation, however, remains unclear because convincing evidence of a vitamin B12deficiency in patients with MS was not documented by the authors. Although the serum vitamin B12 assay is an extremely sensitive test for a vitamin B12 deficiency, it lacks specificity. It has been established that many patients with low serum B12 levels do not have a documentable cobalamin deficiency state. The currently available confirmatory tests for biologically significant vitamin B12 deficiency include determination of serum methylmalonate and homocysteine levels, which have been shown to be elevated in the vast majority of vitamin B12—deficient patients with objective hematologic or neuropsychiatric changes attributable References 1. Reynolds EH, Linnell JC, Faludy JE. Multiple sclerosis associated with vitamin B12 deficiency . Arch Neurol . 1991;48:808-811.Crossref 2. Stabler SP, Allen RH, Savage DG, Lindenbaum J. Clinical spectrum and diagnosis of cobalamin deficiency . Blood . 1990;76:871-881. 3. Allen RH, Stabler SP, Savage DG, Lindenbaum J. Diagnosis of cobalamin deficiency, I: usefulness of serum methylmalonic acid and total homocysteine concentrations . Am J Hematol . 1990;34:90-98.Crossref 4. Green R, Gatautis V, Jacobsen DW. Serum methylmalonic acid (MMA) and homocysteine (HCY) are more specific tests than serum vitamin B12 for identifying true cobalamin (cbl) deficiency . Blood . 1990;76( (suppl 1) ):33A. 5. Ransohoff RM, Jacobsen DW, Green R. Vitamin B12 deficiency and multiple sclerosis . Lancet . 1990;335:1285-1286.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Jul 1, 1992

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