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Vitamin B12 Injections Intramuscular injections are the standard treatment Initial loading phase followed by maintenance doses Often required for life Oral Vitamin B12 High-dose oral supplementation may be effective in some patients Suitable for those who cannot tolerate injections Monitoring Regular blood tests Neurological assessment Monitoring response to therapy Most patients experience rapid improvement in symptoms after starting treatment

For those who responded, this was sustained for a median of 1.5 years