Neuropathy in two cobalamin-deficient breast-fed infants of vegetarian mothers

Renault, Francis; Verstichel, P; Ploussard, J P; Costil, J

doi:10.1002/(sici)1097-4598(199902)22:2<252::aid-mus13>3.0.co;2-d

Cited by 32 publications

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“…Previous studies have demonstrated that there is a positive correlation between the degree of vitamin B 12 deficiency and abnormality of evoked brain potentials (4,6,18,19). Similarly, in this study, VEP and BAEP tests proved abnormal in 3 and 7 subjects who had serum vitamin B 12 levels of <100 pg/mL, respectively.…”

Section: Discussionmentioning

confidence: 98%

“…Similarly, in this study, VEP and BAEP tests proved abnormal in 3 and 7 subjects who had serum vitamin B 12 levels of <100 pg/mL, respectively. Two patients were presented by Renault et al (19), and it was observed that one patient who showed apathy and lack of interest in the environment recovered at the end of the first week following treatment, whereas the neurological findings of the other patient healed after 2 months. The difference in the recovery of these neurological findings has been attributed to late diagnosis and late treatment (19).…”

Section: Discussionmentioning

confidence: 99%

“…Two patients were presented by Renault et al (19), and it was observed that one patient who showed apathy and lack of interest in the environment recovered at the end of the first week following treatment, whereas the neurological findings of the other patient healed after 2 months. The difference in the recovery of these neurological findings has been attributed to late diagnosis and late treatment (19). The persistence of VEP and BAEP abnormality in our patients at 3 months might be associated with delayed diagnosis of vitamin B 12 deficiency and advanced neurological picture.…”

Section: Discussionmentioning

confidence: 99%

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Visual and brainstem auditory evoked potentials in infants withsevere vitamin B12 deficiency

DEMİR¹,

Azhari²,

Abuhandan³

et al. 2015

Turk J Med Sci

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IntroductionVitamin B 12 is commonly found in foods of animal origin and is not synthesized in the human body. Vitamin B 12 , along with folic acid, participates in DNA synthesis and plays a role in nerve myelination, cell division, and proliferation. In babies exclusively fed with breast milk, the most common cause of vitamin B 12 deficiency is insufficient intake from vegetarian or vegan mothers who do not consume foods of animal origin (1). The severity of clinical symptoms is directly related to the severity of vitamin B 12 deficiency in the mother (2). The most common findings of vitamin B 12 deficiency are hematological and neurological signs. Several studies have reported that these neurological signs might be caused by demyelination, dysmyelination, and axonopathy (3). Abnormalities of visual evoked potentials (VEPs) and brainstem auditory evoked potentials (BAEPs) develop secondarily to demyelination and axonopathy caused by vitamin B 12 deficiency. The persistence of VEP and BAEP abnormality in the deficiency of vitamin B 12 might be associated with delayed diagnosis of vitamin B 12 deficiency and advanced neurological picture (3-6). The other findings are as follows: growth-developmental retardation, gastrointestinal motility disorders (diarrhea), hyperpigmentation, stomatitis, glossitis, irritability, weakness, lethargy, hypotonia, ataxia, hyporeflexia, tremor, convulsion, movement disorders, abnormal mental states, retardation in acquired motor skills, and coma (2,4,7-9).We could not find any controlled study in the literature about the effects of vitamin B 12 deficiency on the evoked brain potentials in infants. Thus, in this study we aimed to determine the effects of vitamin B 12 deficiency on VEP and BAEP in infants, and to investigate the results of treatment. Materials and methods Patient selectionA total of 30 infants aged 6-24 months with retardation of mental, motor, cognitive, and social functions and diagnosed with moderate or severe vitamin B 12 deficiency Background/aim: Vitamin B 12 plays an important role in the development of mental, motor, cognitive, and social functions via its role in DNA synthesis and nerve myelination. Its deficiency in infants might cause neuromotor retardation as well as megaloblastic anemia. The objective of this study was to investigate the effects of infantile vitamin B 12 deficiency on evoked brain potentials and determine whether improvement could be obtained with vitamin B 12 replacement at appropriate dosages.Materials and methods: Thirty patients with vitamin B 12 deficiency and 30 age-matched healthy controls were included in the study. Hematological parameters, visual evoked potentials, and brainstem auditory evoked potentials tests were performed prior to treatment, 1 week after treatment, and 3 months after treatment.Results: Visual evoked potentials (VEPs) and brainstem auditory evoked potentials (BAEPs) were found to be prolonged in 16 (53.3%) and 15 (50%) patients, respectively. Statistically significant improvements in VEP and BAEP examinations w...

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Visual and brainstem auditory evoked potentials in infants withsevere vitamin B12 deficiency

DEMİR¹,

Azhari²,

Abuhandan³

et al. 2015

Turk J Med Sci

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“…Religion was asked for the evaluation of the dietary habits 37,38 and one young non Muslim was found to be pure vegetarian who had both the anemia as well as the neurological complaints of paraesthesias and depression as well.…”

Section: 22mentioning

confidence: 98%

Vitamin B12 Deficiency; Frequency of Neurological Manifestations in Quetta

Hassan

Das

Kumar³

et al. 2017

TPMJ

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ORIGINAL PROF-3859 ABSTRACT… Objectives: To determine the frequency of neurological manifestations of vitamin B 12 deficiency and to observe the reversibility of the symptoms after the therapy. Study Design: Descriptive study. Study Design: Descriptive study. Setting: Medicine Department of Bolan Medical Complex Hospital Quetta. Period: One year that is from January 2012 to December 2012. Methodology: 46 patients presented to various OPDS of B.M.C.H.. The inclusion criteria for the patients to be studied were: Anemia, Neurological complaints. Results: Out of 46 patients 26(56%) were males and 20(43%) were the females with a mean age of (40) years.32 (69%) belonged to the rural areas. 45(97%) had mixed diets whereas only one 1(2.1%) young non Muslim was found to be pure vegetarian.32 (69%) patients presented with hematological as well as neurological complaints. 23(30%) had pancytopenia and 9(19.5%) had bicytopenia. 14(30%) presented with neurological complaints only as sacd 6 (13%), ataxia 8 (17%), sensorimotor neuropathies 36 (78%) and dementia 2 (4.3%). In signs glossitis was found in 6(13%), jaundice in 22 (47%), pallor in 32 (69%) proximal myopathy in 12 (26%) out of which 6 (13%) had shoulder girdle and 8 (17%) pelvic girdle myopathy. Impaired position sense was found in 18 (39%) patients and vibration sense in 21(45%) patients. other signs were pigmentation 2(4.3%) hypotonia in 6(13%) Spasticity in 2(4.3%) and Upgoing plantars in 6(13%) patients. Lhermittes sign could be elicited in only 2(4.3%) patients Optic neuritis and optic atrophy was found in 4(8.6%) patients who came with paraplegia and marked anemia. Rhombergs sign was positive in 8(17.3%) who came with clumsiness of gait. Hemoglobin (Hb %) was found to be low in 32(69%) with a mean of 7.2gm%.pancytopenia (anemia+leucopenia+thrombocytopenia) was found in 23(50%) of patients whereas bicytopenia was found only in 9(19.5%) of patients. Hypersegmented W.B.C were very carefully looked for and were found in 20(43%) of cases. ovalomegaloblasts were found in 32 (69%) of cases .both findings of ovalomegaloblasts and hypersegmented w.b.cs were found in 20 (43%). in the rest 14 (30%) the blood investigations were found to be normal. The next investigation in all patients was serum B 12 estimation, It was found that levels below 200pg/ml were found in 95% cases where only 2(4.3%) patients came with levels slightly above 205pg/ml and 210pg/ml. the response to therapy was recorded as reversible and irreversible. the irreversible features were sacd in 6 (13%), optic atrophy in 2 (4.3%), and dementia in 2 (4.3%) patients. the partially reversible features were myelopathy 10 (21%) numbness and paraesthesias 30 (65%) optic neuritis inn 2 (4.3%) patients were assessed on a duration of 24 weeks. partially reversible features were ataxia, in 6 (13%) patients myelopathy in 2 (4.3%) patients dementia in 2 (4.3%) patients and paraesthesias and numbness in 6 (13%) patients over a period of 24 weeks. Conclusion: It is concluded from my study that the neuropsychiatric manif...

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“…Neurological findings in the form of apathy, hypotonia and developmental delay are usually noted in exclusively breast-fed infants of vitamin B12 deficient mothers between the 3rd and 6th months of life, along with anaemia and failure to thrive [4]. Presentation with oedema and hypoalbuminaemia has only been reported once in the literature [6].…”

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confidence: 97%