Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Class Summary

To treat a nutritional neuropathy, replacing the deficient nutrients is necessary. This may involve administration of folate, thiamine (vitamin B₁), nicotinamide, pyridoxine (vitamin B₆), cyanocobalamin (vitamin B₁₂), alpha-tocopherol (vitamin E), vitamin A, or protein.

Thiamine (Thiamilate)

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For thiamine deficiency syndromes.

Niacin (Vitamin B 3 )

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Source of niacin used in tissue respiration, lipid metabolism, and glycogenolysis.

Cyanocobalamin (Crystamine)

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Deoxyadenosylcobalamin and hydroxocobalamin are active forms of vitamin B₁₂in humans. Vitamin B₁₂synthesized by microbes but not humans or plants. Vitamin B₁₂deficiency may result from intrinsic factor deficiency (pernicious anemia), partial or total gastrectomy, or diseases of distal ileum.

Folate (Folvite)

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Important cofactor for enzymes used to produce RBCs.

Alpha-tocopherol (Vita-Plus E Softgels, Vitec, Aquasol E)

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Protects polyunsaturated fatty acids in membranes from attack by free radicals and protects RBCs against hemolysis.

Multivitamins (MVI-12, Cernevit-12)

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Dietary supplement.

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Media Gallery

Pernicious anemia. Characteristic lemon-yellow–tinged pallor with raw-beef tongue lacking filiform papillae. Used with permission from Forbes and Jackson.
Ischemic retinopathy caused by severe megaloblastic anemia.

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Author

Jasvinder Chawla, MD, MBA Chief of Neurology, Hines Veterans Affairs Hospital; Professor of Neurology, Loyola University Medical Center

Jasvinder Chawla, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University in St Louis School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Former Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Additional Contributors

Milind J Kothari, DO Associate Dean, Collegia Program, University of South Florida Morsani College of Medicine

Milind J Kothari, DO is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Neurological Association

Disclosure: Nothing to disclose.

Acknowledgements

Lawrence D Recht, MD Professor of Neurology and Neurosurgery, Department of Neurology and Clinical Neurosciences, Stanford University Medical School

Lawrence D Recht, MD is a member of the following medical societies: American Academy of Neurology, American Association for Cancer Research, American Neurological Association, and Society for Neuroscience

Disclosure: Nothing to disclose.

R Andrew Sewell, MD Associate Research Scientist in Psychiatry and Mental Illness Research, Education,Veterans Affairs Connecticut Health Care System, Yale University School of Medicine

R Andrew Sewell, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, American Pain Society, and American Psychiatric Association

Disclosure: Nothing to disclose.