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Referral to secondary care is indicated for severe or rapidly progressive neurological symptoms, diagnostic uncertainty, suspected bone marrow failure, or in pregnancy or paediatric cases

Especially the B12 form of methylcobalamin has proven to be very effective in many studies

Current Neuropharmacology, 14(8), 857-865

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Clinical trials would need to assess both hemodynamic parameters and clinical outcomes including walking distance, pain scores, and amputation rates to establish therapeutic benefit

Thats changed, he says
