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Secondary progressive MS (SPMS) develops in many RRMS patients over time, characterized by gradual worsening independent of relapses

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Changing patterns of the temperaturemortality association by time and location in the US, and implications for climate change

Effects in the underlying literature are cumulative

Humid heat exposure further increases wakefulness, decreases REM and SWS, and excessively suppresses the decrease in Tcore, whereas Tsk and whole body sweat loss are not affected [43]

It may be that B12 supplementation is only useful for people already deficient in the vitamin, but more research is needed