{
  "abstract": "Background The most common neurological side effect from pyridoxine is peripheral neuropathy. Rare cases of pyridoxine toxicity have described fasciculations. It has been postulated that the fasciculations represented a transient state of peripheral nerve hyperexcitability, which was supported by electromyographic findings of numerous fasciculation potentials of normal morphology, in an otherwise healthy patient. The fasciculations abated with cessation of vitamin B6 supplementation. 1 Case Our case features a 51 year old male with a 12 month history of progressive spasticity and mild fasciculations in all limbs. Following extensive investigation, he was ultimately diagnosed with motor neuron disease (MND). He was prescribed vitamin B6 by a naturopath, after which time the patient and his family noted a marked increase in the extent and persistence of fasciculations. Pyridoxine serology revealed a supratherapeutic level of 726nmol/L (reference 35–110), at which time he ceased taking the B6 vitamin supplements. Over the next fortnight, the patient and his family described a dramatic reduction in his observed fasciculations ‘by at least 70%’.Discussion It is hypothesized that this case represents an instance of pyridoxine neurotoxicity manifesting as transient peripheral nerve hyperexcitability in the context of MND. That the marked exacerbation of fasciculations proved largely reversible with withdrawal of pyridoxine supplementation further suggests the utility of checking pyridoxine levels in the context of\\ clinical presentations associated with peripheral nerve hyperexcitability syndromes.Reference Krishnan D, Kiernan MC. Neurotoxic risks from over-the-counter vitamin supplements. Med J Aust. 2023 Apr 17;218(7):304–306.",
  "authors": [
    {
      "affiliations": [
        "Neuroscience Research Australia, Sydney, NSW, Australia"
      ],
      "name": "Jasmine F Ashhurst"
    },
    {
      "affiliations": [
        "Neuroscience Research Australia, Sydney, NSW, Australia"
      ],
      "name": "Alexandra Thompson"
    },
    {
      "affiliations": [
        "Neuroscience Research Australia, Sydney, NSW, Australia"
      ],
      "name": "Matthew C Kiernan"
    }
  ],
  "title": "3586 Pyridoxine toxicities from over-the-counter vitamin supplements",
  "uid": "1b4f93fe-9a4b-5955-822a-c25d9b37635d"
}