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In newborn screenings where biochemical markers are indicative of vitamin B 12 deficiency, the diagnosis of inborn errors of vitamin B 12 metabolism is performed via functional studies on cultured fibroblasts isolated from skin biopsies (Watkins and Rosenblatt, 2013) or via molecular genetic analysis of putative genes

However, certain medications and substances may still interact with methylcobalamin, potentially altering its absorption or effectiveness

Some treatments might also slow it down

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The most common clinical manifestations are recurrent seizures associated with fever, usually occurring in the neonatal period, early infancy or early childhood