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Vitamin B12 is a water-soluble vitamin essential for red blood cell formation, neurological function, and DNA synthesis

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ALS is mostly diagnosed based on clinical signs, using the revised El Escorial criteria, which require signs of both upper motor neuron (e.g., spasticity, brisk reflexes) and lower motor neuron damage (e.g., muscle wasting, twitching) in multiple body regions (Brotman et al., 2025)

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