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E. H. Reynolds, FRCP; T. Bottiglieri, MSc, PhD; M. Laundy, HNC; R. F. Crellin, MRCP; S. C. Kirker, MRCP(Ire)

Arch Neurol. 1992;49(6):649-652.

Abstract
• We have previously described 10 patients with multiple sclerosis (MS) and unusual vitamin B₁₂ deficiency. We have therefore studied vitamin B₁₂ metabolism in 29 consecutive cases of MS, 17 neurological controls, and 31 normal subjects. Patients with MS had significantly lower serum vitamin B₁₂ levels and significantly higher unsaturated R-binder capacities than neurological and normal controls, and they were significantly macrocytic compared with normal controls. Nine patients with MS had serum vitamin B₁₂ levels less than 147 pmol/L and, in the absence of anemia, this subgroup was significantly macrocytic and had significantly lower red blood cell folate levels than neurological and normal controls. Nine patients with MS had raised plasma unsaturated R-binder capacities, including three patients with very high values. There is a significant association between MS and disturbed vitamin B₁₂ metabolism. Vitamin B₁₂ deficiency should always be looked for in patients with MS. The cause of the vitamin B₁₂ disorder and the nature of the overlap with MS deserve further investigation. Coexisting vitamin B₁₂ deficiency might aggravate MS or impair recovery from MS.

Author Affiliations
From the Department of Neurology, King's College Hospital, London, England (Drs Reynolds, Crellin, and Kirker), and the Department of Haematology, Northwick Park Hospital, London, England (Dr Bottiglieri and Mr Laundy).

Footnotes
Accepted for publication November 21, 1991.

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

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