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In SPMS, characterized by steady deterioration without acute attacks, treatment strategies often involve continuing or altering DMT used during the earlier RRMS phase, such as interferon beta, or considering immune-modulating agents, such as methotrexate, cyclophosphamide, or glucocorticoid pulses [142, 143]

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Low B12 levels have been linked with memory problems and even dementia but studies have not shown any B12 benefit in people with one of these conditions, even in megadoses of 1,000 micrograms