Vitamin B-12 Associated Neurological Diseases Follow-up

Updated: Aug 04, 2016
  • Author: Niranjan N Singh, MD, DM; Chief Editor: Selim R Benbadis, MD  more...
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Follow-up

Further Outpatient Care

Patients with neurologic impairment may require additional care in skilled nursing units or rehabilitation facilities. Outpatient follow-up is required to ensure response to therapy.

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Further Inpatient Care

Once therapy is initiated, hospitalization is only required for patients with life-threatening anemia or with severe neurologic deficits requiring supervision or rehabilitation.

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Inpatient & Outpatient Medications

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  • Cobalamin 100-1000 mcg/mo SC/IM, 1000 mcg/d PO is provided for lifelong maintenance.
  • Compliance must be verified to avoid recurrence of symptoms.
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Deterrence/Prevention

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  • Relatives of patients with PA must be made aware of the increased familial incidence.
  • Individuals with total gastrectomy, pancreatectomy, or atrophic gastritis should undergo periodic testing for vitamin B-12 deficiency.
  • Testing vitamin B-12 (and folate) levels in elderly patients is good practice because of the high incidence of deficiencies. Asymptomatic deficiency should be worked up and treated.
  • Strict vegetarians should supplement vitamin B-12 in their diets.
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Complications

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  • If left untreated, neurologic complications worsen.
  • Severe anemia may lead to congestive heart failure.
  • Incidence of atrophic gastritis, gastric carcinoma, and carcinoid tumors is increased in patients with PA.
  • Patients with PA are at increased risk for other autoimmune disorders, such as myasthenia gravis, Lambert-Eaton myasthenic syndrome, type 1 diabetes mellitus, Hashimoto thyroiditis, hypogammaglobulinemia, vitiligo, and rheumatoid arthritis. [28]
  • Risk of neural tube defects is increased in untreated pregnant women.
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Prognosis

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  • Therapy with vitamin B-12 in subacute combined degeneration stops progression and improves neurologic deficit in most patients.
  • Younger patients with less severe disease and short duration illness do better.
  • In a large retrospective review of 57 patients with subacute combined degeneration, absence of sensory level, absent Rhomberg sign, and flexor planter reflex were associated with good prognosis. [29]
  • On spinal MRI, involvement of less than 7 spinal segments, cord swelling, and enhancement, but not cord atrophy, were associated with better prognosis. [29]
  • Clinical improvement is most pronounced in the first 2 months but continues up to 6 months.
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