; vitamin B6; and, of course, vitamin B12. We know that deficiencies in these things cause clear neurologic issues that are treatable.
He went to our institutions. Everybody did a fabulous job, and almost everything was done, including spinal taps and nerve biopsies, and nothing could be found. I like interesting and strange cases, so he was referred to me. He came in with two banker's boxes full of records, and I thought,. Like all good neurologists, we take it all home and we look through it all. Really, everything had been done.
A B1 level was done once during an earlier evaluation, and it was just barely within normal range, so nobody thought anything of it. The thing was, he would occasionally cheat and that was probably around the time that the original level was done, because it has a waxing/waning presentation. We did his B1 level again and it was very deficient. I gave him B1 injections, B1 orally, found a good source of wheat flour in Utah for him, and taught him how to bake bread.