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Insert the needle with a smooth, decisive motion 90 degrees for IM, 45 degrees for SC
Common neurological manifestations include: Paraesthesia (pins and needles) in the hands and feet Numbness and altered sensation Difficulty with balance and coordination (ataxia) Memory problems and cognitive impairment Mood changes, including depression and irritability In severe cases, visual disturbances and confusion These neurological features arise from demyelination of peripheral nerves and the spinal cord, a condition known as subacute combined degeneration when it affects the posterior and lateral columns of the spinal cord
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The GDS-15 was completed by 34 patients (17 per group), with median scores initially at 2.0 in the loading dose group and 3.5 in the no loading dose group, which adjusted to 2.5 and 2.0 respectively after 90 days
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