ABSTRACT
Nature, and Timing ....................................................................................... 101 6.3 Neurologic Complications Following Bariatric Surgery: Risk Factors
and Mechanisms ........................................................................................... 101 6.4 Nutrient Deficiency and Related Neurologic Manifestations ....................... 102
6.4.1 Thiamine (B1) (Table 6.2) ................................................................. 102 6.4.1.1 Thiamine Deficiency and Bariatric Surgery ...................... 102 6.4.1.2 Physiologic Role of Thiamine ............................................ 102 6.4.1.3 Clinical Manifestations of Thiamine Deficiency .............. 103 6.4.1.4 Diagnosis ............................................................................ 104 6.4.1.5 Management ....................................................................... 106
6.4.2 Vitamin B12 (B12, Cobalamin) (Table 6.3) ......................................... 107 6.4.2.1 B12 Deficiency and Bariatric Surgery ................................. 107 6.4.2.2 Physiologic Role of B12 ....................................................... 108 6.4.2.3 Clinical Manifestations of B12 Deficiency .......................... 110 6.4.2.4 Diagnosis ............................................................................ 110 6.4.2.5 Management ....................................................................... 111
6.4.3 Copper (Table 6.4) ............................................................................ 112 6.4.3.1 Copper Deficiency and Bariatric Surgery .......................... 112 6.4.3.2 Physiologic Role of Copper ................................................ 113 6.4.3.3 Clinical Manifestations of Copper Deficiency .................. 113 6.4.3.4 Diagnosis ............................................................................ 114 6.4.3.5 Management ....................................................................... 114
6.4.4 Vitamin B6 (B6, Pyridoxine) ............................................................. 115 6.4.4.1 B6 Deficiency and Bariatric Surgery .................................. 115 6.4.4.2 Physiologic Role of B6 ........................................................ 115 6.4.4.3 Clinical Significance of B6 Deficiency .............................. 116 6.4.4.4 Diagnosis ............................................................................ 116 6.4.4.5 Management ....................................................................... 116
6.4.5 Folate ................................................................................................ 116 6.4.5.1 Folate Deficiency and Bariatric Surgery ............................ 116 6.4.5.2 Physiologic Role of Folate.................................................. 116 6.4.5.3 Clinical Manifestations of Folate Deficiency .................... 117 6.4.5.4 Diagnosis ............................................................................ 117 6.4.5.5 Management ....................................................................... 117
Optimal functioning of the central and peripheral nervous system is dependent on a constant supply of appropriate nutrients. Particularly important for optimal functioning of the nervous system are the B-group vitamins (thiamine, vitamin B12, niacin, pyridoxine, folate), vitamin E, copper, and vitamin D. The epidemic of obesity and limited efficacy of available medical treatments has resulted in increasing utilization of bariatric surgical procedures for treatment of medically complicated obesity. This has been accompanied by an increased incidence and awareness of neurologic complications resulting from bariatric surgery. These are often related to nutrient deficiencies. The preventable and potentially treatable nature of these disorders makes this an important subject. Prognosis depends on prompt recognition and institution of appropriate therapy.
