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The clinical significance of a one-point change in NTSS-6 score among patients with moderate or severe symptoms in the Metanx group is unclear.(11) Although Yaqub et als study showed symptom improvement in the methylcobalamin group, the results were not compared with the placebo group.(12) Furthermore, Farvid et als study showed no difference in the improvement of symptoms between the vitamin B and non-vitamin B groups

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Non-pharmacological interventions should be emphasized as initial management strategies

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