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However in our opinion, the low probability of MS coincidence with another rare disease, together with the animal studies where MS is never a consideration, makes it more likely that these human examples align with an “inside-out” model (Figure 2), where a primary biochemical derangement of myelin, coupled with an immune predisposition, culminated in a MS-like phenotype

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[5] When B12 and folate deficiency coexist, B12 replacement should be started before or alongside folic acid (typically 5mg daily) to avoid worsening neurological symptoms