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Had low B12 (220 pg/mL, no other tests for homocysteine or MMA), many psychiatric and pain symptoms resolved almost immediately after treatment with methyl B12.)

Have since had several episodes of severe muscle weakness and torso-based muscle spasms.

So how does one tease out myelin damage from B12 from MS-based autoimmune (presumably) attack?

Magnesium levels are good, can't take oral supps but Epsom salt baths brought up levels. Strict AI Paleo diet for 2 years to support celiac, and ai thyroid treatments. I eat tons of veggies daily, fish oil, higher quality meats.

So how does one tease out myelin damage from B12 from MS-based autoimmune (presumably) attack?

Demyelination occurs in cases of B12 deficiency.
It seems that symptoms that continue to get better (or at least don't get worse) once a B12 issue has been definitely been fixed would be from a B12 issue.

Magnesium levels are good, can't take oral supps but Epsom salt baths brought up levels.

May I ask what you mean by "good"?