Vitamin B12 deficiency, seizure, involuntary movements

I read with interest the article by Benbir et al. The paper of the authors seems to change the knowledge about seizure and Vitamin B12 deficiency (VBD). In that paper, three infants with VBD were reported because of seizures following the initiation of intramuscular Vitamin B12 treatment. VBD may cause the involuntary movements (IM) and seizures. The IM can be commonly confused with seizure. I think to look over the IM and seizures. The IM are one of the impressive characteristics on VBD. Some of the patients can exhibit the IM as choreoathetoid movements, rolling movements, jerky movements, tremor before treatment. However some IM such as shaking movements, myoclonus, tremor and chorea, twitching, protrusion or tremor of the tongue, wandering eye movements become visible after the beginning of the treatment. In these cases the IM may appear 2 days after the initiation of cobalamin therapy, usually continue 2—3 weeks. It may be observed at the third month of treatment. Katar et al. reported prevalence of tremor as 12% before treatment. These movements may persist in sleeping or disappear during sleeping. The reports about epileptic seizures of VBD are not much. Generalize tonic-clonic seizure, focal seizure, infantile spasm were described as VBD related seizures. The seizures in these cases usually begin before the treatment with Vitamin B12. The therapy can stop the seizures, promptly. Some patients exhibit therapy resistant seizures. In the case of Korenke et al., a tremor as the first neurological symptom was observed, then mani-