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E. H. Reynolds, FRCP; J. C. Linnell, PhD; J. E. Faludy

Arch Neurol. 1991;48(8):808-811.

Abstract
• We describe 10 patients with a previously unreported, to our knowledge, association of multiple sclerosis and unusual vitamin B₁₂ deficiency. The clinical features and the age at presentation were typical of multiple sclerosis, with eight cases occurring before age 40 years, which is a rare age for vitamin B₁₂ deficiency. Nine patients had hematologic abnormalities, but only two were anemic. All six patients examined had low erythrocyte cobalamin levels. Only two patients had pernicious anemia; in the remaining patients the vitamin B₁₂ deficiency was unexplained. A vitamin B₁₂ binding and/or transport is suspected. The nature of the association of multiple sclerosis and vitamin B₁₂ deficiency is unclear but is likely to be more than coincidental. Further studies of vitamin B₁₂ metabolism, binding, and transport in multiple sclerosis are indicated, as these cases may offer a clue to the understanding of a still mysterious neurologic disorder.

Author Affiliations
From the Department of Neurology, King's College Hospital (Dr Reynolds), and the Department of Child Health, Westminster Children's Hospital (Dr Linnell and Ms Faludy), London, England.

Footnotes
Accepted for publication December 21, 1990.

Reprint requests to the Department of Neurology, King's College Hospital, Denmark Hill, London SE5 9RS, England (Dr Reynolds).

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