Nitrous oxide-induced predominantly motor neuropathies: a follow-up study

Berling, Édouard; Fargeot, Guillaume; Auré, Karine; Tran, Tuan Huy; Kubis, Nathalie; Lozeron, Pierre; Zanin, Adrien

doi:10.1007/s00415-021-10858-2

Cited by 23 publications

(51 citation statements)

References 13 publications

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“…Most case series reported neurological complaints with 23 studies reporting presentations of sensory change, weakness or autonomic dysfunction, [17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] whereas seven described psychiatric symptoms. 18,21,23,27,30,31,33 Other conditions reported included hyperpigmentation, 22,25,39 pruritis 25 and haematological sequelae.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Serum B12 levels were described in 21 case series [17][18][19][20][22][23][24][25][26][27][28][29]31,[33][34][35][36][37][38][39][40] with 243 reported values; of which 111 were low, 126 were normal and six were high. Homocysteine, MMA, haemoglobin and MCV were described in 19, [18][19][20][22][23][24][25][26][27][28][29][31][32][33][34][35][37][38][39] five 24,26,34,35,37 and 12, 18,20,[23][24][25]27,…”

Section: Investigationsmentioning

confidence: 99%

“…MRI spine results were reported in 21 case series with dorsal column abnormalities demonstrated in 18 studies, [17][18][19][20][22][23][24][25]27,[29][30][31][32][33][34][37][38][39] lesions of unspecific location in one study 28 and two reported no cord lesion. 35,40 Cerebral white matter changes were identified in two case series.…”

Section: Investigationsmentioning

confidence: 99%

“…35,40 Cerebral white matter changes were identified in two case series. 22,35 Nerve conduction studies were performed in 16 case series 17,19,20,[22][23][24][27][28][29]31,33,[35][36][37]39,40 with the most common finding being a sensorimotor polyneuro pathy. 17,20,22,27,29,31,33,37,40 With respect to case reports, out of 64 reported MRI spine findings, 52 were abnormal, with dorsal column changes described in 49 subjects.…”

Section: Investigationsmentioning

confidence: 99%

“…B12 replacement therapy was reported in 18 case series. 17,19,20,22,24,25,[27][28][29][31][32][33][35][36][37][38][39][40] Two studies reported methionine replacement, 22,33 three provided physiotherapy, 22,37,38 whereas IVIG 27,35,37 and plasmapheresis 29 were also utilised on presentation or with poor clinical response. Additional therapies included antipsychotics, 21 pregabalin 17 and anticoagulation for pulmonary thromboembolism.…”

Section: Treatmentmentioning

confidence: 99%

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Review article: Clinical manifestations and outcomes of chronic nitrous oxide misuse: A systematic review

Marsden

Sharma

Rotella

2022

Emerg Medicine Australasia

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Recreational nitrous oxide (N2O) use is widespread, and complications associated with its use are increasingly common. We sought to identify risk factors, clinical features and outcomes in individuals presenting with effects of chronic N2O abuse to develop an approach to clinical assessment and management. A systemic literature review was completed with searches conducted across EMBASE, MEDLINE, PSYCINFO and Cochrane databases. Our search strategy identified 612 studies, 105 met inclusion criteria, and 10 were added via hand search. Subjects from 24 case series and 91 case reports were typically in their 20s, using over 100 bulbs daily for several months. Neurological presentations, including sensory change, gait disturbance or weakness, were characteristic. Serum Vitamin B12 was normal or raised in 133 out of 243 case series subjects and 37 out of 84 reports. Serum homocysteine and methylmalonic acid were usually raised. Macrocytosis and anaemia were not commonly seen. MRI findings were abnormal with dorsal column change where specified, typically involving the cervical spine. Nerve conduction studies mostly reported a sensorimotor polyneuropathy. B12 replacement was the treatment of choice and partial recovery was most reported. This review highlights the dose‐dependent nature of chronic N2O toxicity and recognises functional B12 deficiency as the cause. As B12 is often normal, homocysteine and methylmalonic acid are important biomarkers of disease. An approach to diagnosis is offered but requires validation in prospective studies. Research exploring B12 and methionine therapy is required to refine management.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Investigationsmentioning

confidence: 99%

Section: Investigationsmentioning

confidence: 99%

Section: Investigationsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Review article: Clinical manifestations and outcomes of chronic nitrous oxide misuse: A systematic review

Marsden

Sharma

Rotella

2022

Emerg Medicine Australasia

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Severe length‐dependent peripheral polyneuropathy in a patient with subacute combined spinal cord degeneration secondary to recreational nitrous oxide abuse: A case report and literature review

Bonev

Wyatt

Barton

et al. 2023

Clinical Case Reports

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Nitrous oxide abuse can have detrimental effects on the central and peripheral nervous systems. This case study report aims to demonstrate a combination of severe generalized sensorimotor polyneuropathy and cervical myelopathy related to vitamin B 12 deficiency following nitrous oxide abuse. We present a clinical case study and literature review examining primary research—published between 2012 and 2022—reporting nitrous oxide abuse affecting the spinal cord (myelopathy) and peripheral nerves (polyneuropathy); 35 articles were included in the review with a total of 96 patients, where the mean “patients” age was 23.9 years and were in a 2:1 male/female ratio. Of the 96 cases, within the review, 56% of patients were diagnosed with polyneuropathy, most commonly impacting the nerves of the lower limb (62%), while 70% of patients were diagnosed with myelopathy, most commonly impacting the cervical region (78%) on the spinal cord. In our clinical case study, a 28‐year‐old male underwent a multitude of diagnostic investigations for bilateral “foot drop” and sense of lower limb stiffness as ongoing complications of a vitamin B 12 deficiency secondary to recreational nitrous oxide abuse. Both the literature review and our case report emphasize the dangers of recreational nitrous oxide inhalation, colloquially termed “ nanging ” and the risks it presents to both the central and peripheral nervous systems, which is erroneously considered by many recreational drug users to be less harmful than other illicit substances.

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