Peripheral Neuropathy Due to Cobalamin Deficiency

Overview

Journal Curr Treat Options Neurol

Specialty Neurology

Date 2002 Apr 5

PMID 11931726

Citations 14

Authors

David S Saperstein

Richard J Barohn

Affiliations

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Abstract

Vitamin B12, or cobalamin (Cbl), deficiency can produce a number of neurologic complications, including myelopathy, peripheral neuropathy, optic neuropathy, and dementia. The myelopathy, combined systems disease, is probably the most well known manifestation, and is usually readily recognized. The frequency with which peripheral neuropathy is the sole presenting feature of Cbl deficiency is a point of controversy. The prevalence and the clinical and electrophysiologic features of Cbl deficiency peripheral neuropathy have not been well characterized. In addition, there is evidence that the commonly used assays of serum Cbl are not adequately sensitive. Testing the serum metabolites methylmalonic acid and homocysteine can increase the identification of Cbl deficient patients. Treatment with parenteral Cbl injections may not produce improvement of neurologic deficits, but might prevent worsening. In some patients with Cbl deficiency, oral Cbl may be an effective therapy.

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References

Miller A, SLINGERLAND D, Cardarelli J, BURROWS B . Further studies on the use of serum gastrin levels in assessing the significance of low serum B12 levels. Am J Hematol. 1989; 31(3):194-8. DOI: 10.1002/ajh.2830310309. View

Carmel R . Malabsorption of food cobalamin. Baillieres Clin Haematol. 1995; 8(3):639-55. DOI: 10.1016/s0950-3536(05)80224-0. View

Fine E, Soria E, Paroski M, Petryk D, Thomasula L . The neurophysiological profile of vitamin B12 deficiency. Muscle Nerve. 1990; 13(2):158-64. DOI: 10.1002/mus.880130213. View

Kinsella L, Green R . 'Anesthesia paresthetica': nitrous oxide-induced cobalamin deficiency. Neurology. 1995; 45(8):1608-10. DOI: 10.1212/wnl.45.8.1608. View

Healton E, Savage D, Brust J, Garrett T, Lindenbaum J . Neurologic aspects of cobalamin deficiency. Medicine (Baltimore). 1991; 70(4):229-45. DOI: 10.1097/00005792-199107000-00001. View

Wolfe G, Baker N, Amato A, Jackson C, Nations S, Saperstein D . Chronic cryptogenic sensory polyneuropathy: clinical and laboratory characteristics. Arch Neurol. 1999; 56(5):540-7. DOI: 10.1001/archneur.56.5.540. View

Kuzminski A, Del Giacco E, Allen R, Stabler S, Lindenbaum J . Effective treatment of cobalamin deficiency with oral cobalamin. Blood. 1998; 92(4):1191-8. View

. Chronic symmetric symptomatic polyneuropathy in the elderly: a field screening investigation in two Italian regions. I. Prevalence and general characteristics of the sample. Italian General Practitioner Study Group (IGPSG). Neurology. 1995; 45(10):1832-6. DOI: 10.1212/wnl.45.10.1832. View

Metz J, Bell A, Flicker L, Bottiglieri T, Ibrahim J, Seal E . The significance of subnormal serum vitamin B12 concentration in older people: a case control study. J Am Geriatr Soc. 1996; 44(11):1355-61. DOI: 10.1111/j.1532-5415.1996.tb01407.x. View

10.

Carmel R . Current concepts in cobalamin deficiency. Annu Rev Med. 2000; 51:357-75. DOI: 10.1146/annurev.med.51.1.357. View

11.

Flippo T, Holder Jr W . Neurologic degeneration associated with nitrous oxide anesthesia in patients with vitamin B12 deficiency. Arch Surg. 1993; 128(12):1391-5. DOI: 10.1001/archsurg.1993.01420240099018. View

12.

Chalk C . Acquired peripheral neuropathy. Neurol Clin. 1997; 15(3):501-28. DOI: 10.1016/s0733-8619(05)70331-5. View

13.

Lindenbaum J, Savage D, Stabler S, Allen R . Diagnosis of cobalamin deficiency: II. Relative sensitivities of serum cobalamin, methylmalonic acid, and total homocysteine concentrations. Am J Hematol. 1990; 34(2):99-107. DOI: 10.1002/ajh.2830340205. View

14.

Kosik K, Mullins T, Bradley W, Tempelis L, Cretella A . Coma and axonal degeneration in vitamin B12 deficiency. Arch Neurol. 1980; 37(9):590-2. DOI: 10.1001/archneur.1980.00500580086019. View

15.

Savage D, Lindenbaum J, Stabler S, Allen R . Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med. 1994; 96(3):239-46. DOI: 10.1016/0002-9343(94)90149-x. View

16.

Tomoda H, Shibasaki H, Hirata I, Oda K . Central vs peripheral nerve conduction. Before and after treatment of subacute combined degeneration. Arch Neurol. 1988; 45(5):526-9. DOI: 10.1001/archneur.1988.00520290058014. View

17.

Pennypacker L, Allen R, Kelly J, MATTHEWS L, Grigsby J, Kaye K . High prevalence of cobalamin deficiency in elderly outpatients. J Am Geriatr Soc. 1992; 40(12):1197-204. View

18.

Holloway K, Alberico A . Postoperative myeloneuropathy: a preventable complication in patients with B12 deficiency. J Neurosurg. 1990; 72(5):732-6. DOI: 10.3171/jns.1990.72.5.0732. View

19.

Hadzic A, Glab K, Sanborn K, Thys D . Severe neurologic deficit after nitrous oxide anesthesia. Anesthesiology. 1995; 83(4):863-6. DOI: 10.1097/00000542-199510000-00028. View

20.

Lindenbaum J, Rosenberg I, Wilson P, Stabler S, Allen R . Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr. 1994; 60(1):2-11. DOI: 10.1093/ajcn/60.1.2. View