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The active folate is immediately bioavailable, crossing the blood-brain barrier and entering the methylation cycle without requiring any enzymatic conversion, ensuring that even those with severe MTHFR mutations receive the full therapeutic benefit

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To prevent this complication, steroids should first be administered at low doses, on alternate days, and gradually increased over time.Alternatively, acetylcholinesterase inhibitors, plasma exchange, or immunoglobulin can also be used to treat these exacerbations (Meriggioli 2009)