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Nevertheless, we argue that a cytodegeneration of the myelinating unit may be the most proximal event, which could be potentially driven by a protein misfolding mechanism like most other neurodegenerative disorders

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While B12 is generally safe, caution is needed in specific clinical situations: Lebers Disease (Hereditary Optic Neuropathy): B12 injections are generally contraindicated or should be used with extreme caution, as they may potentially aggravate optic atrophy in this rare condition