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Serum cobalamin deficiency is uncommon in multiple sclerosis
D E Goodkin1, D W Jacobsen, N Galvez
1Department of Neurology, Cleveland Ohio Clinic Foundation.
Archives of Neurology
|November 1, 1994
Summary
Low serum cobalamin (Cbl) levels are common in multiple sclerosis (MS) patients, but biologically severe Cbl deficiency is rare. Further testing for metabolites like methylmalonic acid (MMA) and homocysteine (HCY) is needed to confirm deficiency.
Area of Science:
- Neurology
- Clinical Biochemistry
Background:
- Lower serum cobalamin (Cbl) levels are observed in multiple sclerosis (MS) patients compared to controls.
- The clinical significance of these low Cbl levels, indicated by metabolite accumulation, remains unclear.
Purpose of the Study:
- To determine the frequency of serum Cbl deficiency in patients with MS and idiopathic myelopathy (MYL).
- To assess the biologic importance of low screening Cbl levels by measuring specific metabolites.
Main Methods:
- Serum Cbl and folate levels were measured in 165 patients with MS or MYL.
- Methylmalonic acid (MMA) and homocysteine (HCY) levels were assessed in patients with Cbl < 301 pg/mL.
Main Results:
- A Cbl level < 301 pg/mL was found in 19.4% of MS patients.
- Only 4.2% of MS patients exhibited elevated MMA or HCY levels, indicating biologically severe Cbl deficiency.
Conclusions:
- While low screening Cbl levels are frequent in MS patients, biologically severe Cbl deficiency is uncommon.
- Elevated MMA or HCY levels are necessary to confirm clinically significant Cbl deficiency in MS and MYL.