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Subacute Combined Degeneration

by Michael Rubin, MDCM

Subacute combined degeneration is progressive degeneration of the spinal cord due to vitamin B 12 deficiency.

  • Nerve fibers that control movement and sensation are damaged.

  • People have general weakness, tingling and numbness in the hands and feet, and stiff limbs and may become irritable, drowsy, and confused.

  • Blood tests can confirm vitamin B 12 deficiency.

  • Vitamin B 12 , if promptly given by injection or by mouth, usually results in complete recovery.

This disorder affects about 1 of 10,000 people, usually those older than 40.

It is due to a deficiency of vitamin B 12 , which usually also causes pernicious anemia (see Vitamin B 12 Deficiency). Usually, the deficiency is not related to diet but to the body's inability to absorb vitamin B 12 .

Vitamin B 12 is necessary for the formation and maintenance of a fatty sheath (myelin sheath) that surrounds some nerve cells and that speeds transmission of nerve signals. In subacute combined degeneration, the sheath is damaged, causing sensory and motor nerve fibers from the spinal cord to degenerate. The brain, nerves of the eyes, and peripheral nerves are sometimes also damaged.

Symptoms

The disorder begins with a general feeling of weakness. Tingling, a pins-and-needles sensation, and numbness are felt in both hands and feet. These sensations tend to be constant and to gradually worsen. People may not be able to feel vibrations and may lose the sense of where their limbs are (position sense). The limbs feel stiff, movements become clumsy, and walking may become difficult. Reflexes may be decreased, increased, or absent. Rarely, vision is reduced.

People who have this disorder may become irritable, apathetic, drowsy, suspicious, and confused. Their emotions may change rapidly and unpredictably. Rarely, dementia develops.

Diagnosis

  • Blood tests

Blood tests to measure levels of vitamin B 12 can confirm the deficiency.

Treatment

  • Injections of vitamin B 12

Recovery is more likely if the disorder is treated early. When treated within a few weeks after symptoms appear, most people recover completely. If treatment is delayed, the progression of symptoms may be slowed or stopped, but full recovery of lost function is less likely.

Most people are immediately given injections of vitamin B 12 , which are continued indefinitely to prevent symptoms from recurring. Large doses of vitamin B 12 taken by mouth can be used if the deficiency is mild and symptoms of nerve damage have not developed.