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-Syn oligomers cause massive degeneration and loss of nigrostriatal dopaminergic neurons, in turn inducing PD through multiple mechanisms, involving mitochondrial dysfunction, endoplasmic reticulum stress, proteasomal influences, neuroglial cellular and inflammatory responses, membrane damage, synaptic dysfunction, autophagy and lysosomal dysfunction (Bengoa-Vergniory et al., 2017)

That means: Hypokalemia can develop or worsen which can lead to: Cardiac arrhythmias Muscle weakness QT prolongation In severe cases, sudden cardiovascular instability This is a classic board-style pearl that many clinicians forget because B12 feels benign. But in profoundly deficient patientsespecially those with severe megaloblastic anemiarepletion is metabolically active treatment