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Donald E. Goodkin, MD; Donald W. Jacobsen, PhD; Ralph Green, MD
The Cleveland Clinic Foundation Area U-10 9500 Euclid Ave Cleveland, OH 44195-5244

Arch Neurol. 1992;49(7):683.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—The recent article by Reynolds et al¹ on potential association of vitamin B₁₂ "deficiency" and multiple sclerosis (MS) is of considerable interest to patients with MS and physicians involved in their care. The significance of this observation, however, remains unclear because convincing evidence of a vitamin B₁₂deficiency in patients with MS was not documented by the authors. Although the serum vitamin B₁₂ assay is an extremely sensitive test for a vitamin B₁₂ deficiency, it lacks specificity. It has been established that many patients with low serum B₁₂ levels do not have a documentable cobalamin deficiency state. The currently available confirmatory tests for biologically significant vitamin B₁₂ deficiency include determination of serum methylmalonate and homocysteine levels, which have been shown to be elevated in the vast majority of vitamin B₁₂—deficient patients with objective hematologic or neuropsychiatric changes attributable . . . [Full Text PDF of this Article]

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