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The patient had no clinical or neurological symptoms and suffered no seizures on continuous phenytoin medication (300 mg/day)

When commencing B12 replacement therapy, it is essential to recognise that pre-existing joint conditions will not resolve with vitamin supplementation alone and may require separate rheumatological assessment and management according to NICE guidelines

Additionally, ALC acts as a neuroprotective agent, guarding against cognitive decline and boosting mood

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These studies have shown that T21 is associated with reduced mitochondrial structure and vascularization, as well as decreased connectivity within the mitochondrial network, when compared to normal mitochondria (Zamponi and Helguera 2019