Vitamin B12, demyelination, remyelination and repair in MS.
Multiple Sclerosis (MS) and vitamin B12 deficiency share common inflammatory and neurodegenerative pathophysiological characteristics. Due to similarities in the clinical presentations and MRI findings, the differential diagnosis between vitamin B12 deficiency and MS may be difficult. Additionally, low or decreased levels of vitamin B12 have been demonstrated in MS patients. Moreover, recent studies suggest that vitamin B12, in addition to its known role as a co-factor in myelin formation, has important immunomodulatory and neurotrophic effects. These observations raise the questions of possible causal relationship between the two disorders, and suggest further studies of the need to close monitoring of vitamin B12 levels as well as the potential requirement for supplementation of vitamin B12 alone or in combination with the immunotherapies for MS patients.
While I knew that Vitamin B12 deficiency was one of those things that’s typically ruled out when a diagnosis of MS is being considered, I found a lot I didn’t know (no surprise there ) when I read the article.
The neurologic manifestations begin pathologically with demyelination, followed by axonal degeneration and eventual irreversible damage due to axonal death…The patient first notices general weakness and parasthesias. As the illness progresses the gait becomes unsteady and stiffness and weakness of the limbs develop, as well as ataxic paraplegia. The Lhermitte phenonmenon is not an uncommon finding. Mental signs are frequent and range from irritability, apathy, somnolence and emotional instability to marked confusional or depressive states. Visual impairment due to optic neuropathy may occasionally be the earliest or sole manifestation.
The diagnosis of cobalamin (B12) deficiency is typically based on measurement of serum vitamin B12. However, about 50% of patients with subclinical disease have normal B12 levels.
….low or decreased levels of Vitamin B12 have been demonstrated in MS patients…..
…cobalamin deficiency may exacerbate existing MS by worsening the inflammatory and demyelination processes, as well as slowing remyelination and repair….
….High dose methylprednisolone therapy of MS patients was reported to lead to a significant decrease in vitamin B12 CSF levels and to a trend of reduction in serum B12 levels.….
A study recently conducted in our laboratory demonstrated that immuno-therapy of MS patients with IFN-ß and to a lesser extent with Cop-1 (Copaxone) is associated with a significant reduction in vitamin B12 serum levels.
Overall it looks to me like Vitamin B12 supplementation might be a really good thing for lots of reasons. Are there any reasons why people with MS should not use Vitamin B 12?