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This self-perpetuating cycle of mitochondrial damage and oxidative injury progressively worsens mitochondrial pathology, constituting a key mechanistic driver of MMA-associated neurological damage (Dimitrov et al

These forms slightly differ in function, but they ultimately contribute to similar metabolic pathways related to energy production

Oxidative stress markers -Serum malondialdehyde (MDA): the lipid peroxidation marker that reflects the oxidative stress status was measured using the thiobarbituric acid reactive substances (TBARS) method using a commercial kit (Biodiagnostic, Egypt)

Fowler, B., Leonard, J

Primary pain in ALS includes neuropathic pain and pain due to spasticity or cramps, whereas secondary pain is mainly nociceptive and may appear as muscle weakness and atrophy progress [83]