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When side effects do occur, they are typically mild and may include: Mild gastrointestinal symptoms such as nausea, diarrhoea, or upset stomach, particularly when starting supplementation or taking high doses on an empty stomach Skin reactions including itching, rash, or a sensation of swelling, though these are uncommon Headache or dizziness in some individuals, particularly with intramuscular injections Injection site reactions (pain, redness, or swelling) when B12 is administered via intramuscular injection for deficiency treatment It is important to note that serious adverse effects are rare

Most supporting data are preclinical or small uncontrolled human reports, and the marketed benefits should be read as hypotheses

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This could be explained by the low sensitivity of conventional MRI for SACD of cord, which most often requires clinical diagnosis