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The injections are generally well-tolerated

Jacquot JP

StatPearls notes that high-dose oral B has been shown effective for maintenance, but recommendations are to always use the parenteral route in severe neurological manifestations

Energy and recovery patterns Marked fatigue after ordinary activity Exercise intolerance or low physical endurance Delayed recovery after infection Variable energy across the day Worsening after fasting or missed meals Neurologic and stress patterns Variable cognitive stamina Brain fog or reduced focus during fatigue Sensory worsening during illness or stress Temperature sensitivity Regression or functional loss during metabolic stress Testing Undermethylation and Mitochondrial Dysfunction in Autism Testing should distinguish possible methylation impairment from mitochondrial stress, oxidative damage, nutrient deficiency and other biochemical patterns that may produce overlapping symptoms