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Individuals at risk of vitamin B12 deficiency include older adults, people with gastrointestinal disorders, those who have had gastrointestinal surgeries, individuals on a strict vegan diet, individuals who take metformin for blood sugar control, and people taking proton pump inhibitors for chronic heartburn

Of note, many of these cases exhibit CSF oligoclonal bands, Gd-enhancing lesions on MRI and clinical response to immunosuppressionall features very typical of MSindicating that secondary immune responses to a primary trigger can play a significant role in the final clinical phenotype