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Another preclinical study using presymptomatic and symptomatic SOD1 G93A transgenic mice revealed an association between the accumulation of ceramides and cholesterol esters in the spinal cords of ALS patients and OS, thus highlighting the pivotal role of OS in inducing an alteration in the metabolism of sphingolipids metabolism which mediates MN death in ALS [112]

Patients typically receive injections once or twice weekly for the first two weeks, followed by monthly maintenance doses, making the treatment cost-effective for those requiring consistent B12 supplementation

Topical use typically requires 4-8 weeks of consistent application before changes become visible, with maximum benefits at 3-6 months

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