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Once liquid is added, the vial becomes a short-term refrigerated research material with tighter sterility, temperature, and handling requirements

Some patients may notice symptoms returning before their next scheduled injection, particularly if they have higher metabolic demands or ongoing neurological involvement

Always calculate from the actual vial amount and water volume rather than copying a syringe-unit number from another vial

Common neurological manifestations include: Paraesthesia (pins and needles) in the hands and feet Numbness and altered sensation Difficulty with balance and coordination (ataxia) Memory problems and cognitive impairment Mood changes, including depression and irritability In severe cases, visual disturbances and confusion These neurological features arise from demyelination of peripheral nerves and the spinal cord, a condition known as subacute combined degeneration when it affects the posterior and lateral columns of the spinal cord

Eleven of the patients who received lidocaine reported reduced pain

They fail others entirely