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each case is judged individually.11 Solid evidence on the safety of parenteral, lifelong, high dose hydroxocobalamin is available from decades of treating patients with inborn errors of B 12 metabolism (eg, cobalamin C deficiency).6768 Symptom monitoring Monitor symptoms regularly (eg, every two to three months) as they may reappear, even after several months, if injection frequency is reduced

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Polymorphisms in various genes involved in vitamin B 12 metabolism, including the genes encoding the intrinsic factor-cobalamin receptor (60) and the holo-transcobalamin receptor (61), have been associated with increased NTD risk in some studies

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Many patients report mood stabilization and improved resilience