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Elevated MMA levels in patients with vitamin B12 deficiency can contribute to myelin damage (myelopathy) and, consequently, peripheral and autonomic neuropathy ( Cobalamin deficiency can lead to neurological manifestations such as progressive axonal demyelination, impaired peripheral and sensory nerve function, areflexia, loss of proprioception and vibration sensitivity, and subacute combined spinal cord degeneration (70)

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7 In regards to horses, pastes and suspensions are two of the preferred dosage forms, though powders sprinkled over food are sometimes used as well