Vitamin B-12, also known as cobalamin, is a large and complex nutrient containing the metal ion cobalt. In your body, the vitamin is essential for an enzyme responsible for the synthesis of methionine from homocysteine. If this enzyme is not working properly, homocysteine will accumulate in your blood, increasing your risk of heart disease. Vitamin B-12 is also required for the proper functioning of another enzyme that is involved in the formation of hemoglobin and the metabolism of fats and proteins.
Myelopathy
Myelopathy refers to a disorder of the spine, characterized by a gradual loss of nerve function that manifests itself as loss in movement and sensation. There are various causes of myelopathy, including trauma, cancer, osteoarthritis, heavy metal poisoning, copper deficiency and vitamin B-12 deficiency. Myelopathy caused by vitamin B-12 deficiency is known as subacute combined degeneration (SCD).
B-12 Sources and Deficiencies
Foods of animal origin, such as meat, fish, poultry, dairy and eggs, are generally good sources of vitamin B-12. However plants do not synthesize the vitamin, and therefore if you are a strict vegan you will need to rely on supplements and fortified breakfast cereals. The elderly and persons with gastrointestinal disorders are also at risk of deficiency because of reduced absorption. Deficiency symptoms of vitamin B-12 include megaloblastic anemia, numbness and tingling in the limbs, loss of appetite, constipation and myelopathy.
Diagnosis
Diagnosis of vitamin B-12 deficiency myelopathy includes a physical examination, checking for general vitamin B-12 deficiency symptoms; blood tests for vitamin B-12 levels and for metabolites involved in B-12 metabolism; and spine MRI. Generally, the first B-12 deficiency symptoms you would notice are shortness of breath as a result of anemia and tingling in the limbs.
Treatment
Treatment involves supplementing with megadoses of vitamin B-12, for example, 2,000 micrograms administered subcutaneously every two weeks for three months and then monthly thereafter, as described in the March 2002 issue of "Mayo Clinic Proceedings." Similarly, the November 2008 issue of "Singapore Medical Journal" advises treatment with 1,000 micrograms of B-12 intramuscularly daily for a week and then weekly for six weeks. Improvements will be seen after a few weeks. If the condition is treated early, complete resolution of the symptoms is likely; however, if left untreated for long, the condition can become irreversible. You should always consult your doctor before starting any supplement or treatment.
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