Er zijn de afgelopen jaren een aantal wetenschappelijke artikelen gepubliceerd die suggereren dat hooggedoseerde (parenterale) vitamine B12 behandeling een gunstige rol kan spelen bij aandoeningen, die niet gekarakteriseerd worden door een B12 tekort. Dit zijn aandoeningen als neuropathie, multiple sclerose, amyotrofe lateraal sclerose, sepsis, en de ziekte van Parkinson. De rationale hiervoor is dat vitB12 een aantal belangrijke functies en effecten heeft op de zenuwfunctie en in het brein. Hieronder vindt u de belangrijkste recente bevindingen op dit gebied.
Efficacy and Safety of Ultrahigh-Dose Methylcobalamin in Early-Stage Amyotrophic Lateral Sclerosis: A Randomized Clinical Trial.
Oki R, Izumi Y, Fujita K, Miyamoto R, Nodera H, Sato Y, Sakaguchi S, Nokihara H, Kanai K, Tsunemi T, Hattori N, Hatanaka Y, Sonoo M, Atsuta N, Sobue G, Shimizu T, Shibuya K, Ikeda K, Kano O, Nishinaka K, Kojima Y, Oda M, Komai K, Kikuchi H, Kohara N, Urushitani M, Nakayama Y, Ito H, Nagai M, Nishiyama K, Kuzume D, Shimohama S, Shimohata T, Abe K, Ishihara T, Onodera O, Isose S, Araki N, Morita M, Noda K, Toda T, Maruyama H, Furuya H, Teramukai S, Kagimura T, Noma K, Yanagawa H, Kuwabara S, Kaji R; Japan Early-Stage Trial of Ultrahigh-Dose Methylcobalamin for ALS (JETALS) Collaborators.
JAMA Neurol. 2022 Jun 1;79(6):575-583. doi: 10.1001/jamaneurol.2022.0901.
In vivo studies have shown that ultrahigh-dose methylcobalamin injections inhibited the progression of motor symptoms and neuropathological changes in a wobbler mouse model of ALS. A clinical pilot study demonstrated that intramuscular administration of ultrahigh-dose methylcobalamin increased the amplitude of compound muscle action potentials in patients with ALS. Results of this randomized clinical trial showed that ultrahigh-dose methylcobalamin was efficacious in slowing functional decline in patients with early-stage ALS and with moderate progression rate and was safe to use during the 16-week treatment period.
High-Dose IV Hydroxocobalamin (Vitamin B12) in Septic Shock: A Double-Blind, Allocation-Concealed, Placebo-Controlled Single-Center Pilot Randomized Controlled Trial (The Intravenous Hydroxocobalamin in Septic Shock Trial).
Patel JJ, Willoughby R, Peterson J, Carver T, Zelten J, Markiewicz A, Spiegelhoff K, Hipp LA, Canales B, Szabo A, Heyland DK, Stoppe C, Zielonka J, Freed JK.
Chest. 2023 Feb;163(2):303-312. doi: 10.1016/j.chest.2022.09.021. Epub 2022 Sep 26.
High-dose IV hydroxocobalamin scavenges and prevents H2S formation, which may restore vascular tone and may accentuate recovery. This pilot trial established favorable feasibility metrics. Consistent with the proposed mechanism of benefit, high-dose IV hydroxocobalamin compared with placebo was associated with reduced vasopressor dose and H2S levels at all time points and without serious adverse events. These data provide the first proof of concept for feasibility of delivering high-dose IV hydroxocobalamin in septic shock.
A randomised placebo controlled exploratory study of vitamin B-12, lofepramine, and L-phenylalanine (the “Cari Loder regime”) in the treatment of multiple sclerosis.
Wade DT, Young CA, Chaudhuri KR, Davidson DL.
J Neurol Neurosurg Psychiatry. 2002 Sep;73(3):246-9. doi: 10.1136/jnnp.73.3.246.
Patients with multiple sclerosis improved by 2 GNDS points after starting vitamin B-12 injections. The addition of lofepramine and L-phenylalanine added a further 0.6 points benefit. More research is needed to confirm and explore the significance of this clinically small difference.
Recidiverende aften en vitamine B12
Anke Griffioen Arie Knuistingh Neven
Huisarts& Wetenschap 2012, nr 3, blz 138
Vitamine B12 lijkt effectief bij de behandeling van recidiverende aften. Het is onduidelijk wat de effectiefste manier van toedienen is. Bij patiënten met recidiverende aften die weinig baat hebben bij symptomatische therapie zou een behandeling met vitamine B12 kunnen worden overwogen, ook wanneer zij een normale serumvitamine-B12-spiegel hebben.
Parkinson’s disease and vitamins: a focus on vitamin B12.
Rekik A, Santoro C, Poplawska-Domaszewicz K, Qamar MA, Batzu L, Landolfo S, Rota S, Falup-Pecurariu C, Murasan I, Chaudhuri KR.
J Neural Transm (Vienna). 2024 Apr 11. doi: 10.1007/s00702-024-02769-z.
Recent studies have suggested that Vit B12 deficiency along with the induced hyperhomocysteinemia are correlated with specific PD phenotypes characterized with early postural instability and falls and more rapid motor progression, cognitive impairment, visual hallucinations and autonomic dysfunction. Specific clinical features such as polyneuropathy have also been linked to Vit B12 deficiency specifically in context of intrajejunal levodopa therapy. In this review, we explore the link between Vit B12 and PD in terms of physiopathology regarding dysfunctional neural pathways, neuropathological processes as well as reviewing the major clinical traits of Vit B12 deficiency in PD and Levodopa-mediated neuropathy. Finally, we provide an overview of the therapeutic effect of Vit B12 supplementation in PD and posit a practical guideline for Vit B12 testing and supplementation.
Tenslotte beschrijven onderzoekers uit Maastricht, onder leiding van de internist Roger Rennenberg, in het november nummer van het NTVG hoe zij met hoge doseringen vitamine B12 het leven hebben gered van iemand met een cyanide vergiftiging:
[Intoxication due to apricot pits].
Derks JL, Slikkerveer M, Janssen R, Rennenberg RJMW.
Ned Tijdschr Geneeskd. 2024 Oct 22;168:D8046.
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