Nitrous oxide-induced subacute combined degeneration of the cord: diagnosis and treatment

Paris, Alvar; Lake, Luke; Albert, Jacobo; Workman, Anna; Walton, Joseph P.; Hayton, Tom; Evangelou, Nikos; Lilleker, James B; Ayling, Ruth M; Nicholl, David; Noyce, Alastair

doi:10.1136/pn-2022-003631

Cited by 29 publications

(46 citation statements)

References 39 publications

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“…Guy’s and St Thomas’ NHS Foundation Trust said that it has seen an increase in people presenting with peripheral neuropathy symptoms associated with chronic nitrous oxide use—from four in 2020 to seven in 2021 and 32 in 2022. The Royal London Hospital reported diagnosing and treating one case of nitrous oxide induced subacute degeneration of the spinal cord on average every nine days 5…”

Section: Neurological Harmsmentioning

confidence: 99%

Nitrous oxide: Advisory panel rejects calls for ban on recreational use

Wise¹

2023

BMJ

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Section: Neurological Harmsmentioning

confidence: 99%

Nitrous oxide: Advisory panel rejects calls for ban on recreational use

Wise¹

2023

BMJ

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“…The management of the complications of N 2 O abuse is to recommend immediate cessation of inhalation and intramuscular injections of hydroxocobalamin 1 mg three times a week for at least 2s weeks and continue until there is no further neurological improvement. This regimen has been extrapolated from standard SCD treatment as a result of vitamin B12 deficiency [31 ▪▪ ].…”

Section: Nitrous Oxide (N20)mentioning

confidence: 99%

Toxic neuropathies

Rossor,

Manji

2023

Current Opinion in Neurology

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Purpose of review Immunotherapy has had a significant impact on the treatment of an increasing number of cancers as well as in inflammatory, rheumatological and gastroenterological conditions. Recreational nitrous oxide use is now a global epidemic. Linezolid is now recommended for the treatment of drug-resistant tuberculosis (TB); neuropathy is a significant cause of morbidity. Global warming will result in increasing toxin exposure, such as ciguatera, in previously unaffected areas. Recent findings With increasing experience, the pathophysiology underlying the neuropathic complications of these drugs has become clear with guidelines now available, for the complications of immune check-point inhibitors and nitrous oxide toxicity. The optimum dose and duration of treatment for resistant TB with regimens, including linezolid, has been ascertained. Summary Although neuropathic complications with immunotherapy are relatively rare, it is essential that they are recognized and treated early. Nitrous oxide toxicity should be in the differential diagnosis for all patients, particularly those of younger age, presenting with a neuropathy or myleo-neuropathy. Ciguatera toxicity is under recognized and its geographical spread will increase due to global warming. Further research is necessary on the mechanisms and treatment of both acute and chronic effects, which at present, are only symptomatic.

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“…Once history of chronic nitrous oxide abuse was clear and parenteral B12 supplementation was started, the patients made partial to full recoveries. The Royal London Hospital has recently reported treating one case of subacute degeneration of the spinal cord secondary to nitrous oxide use every 9 days [4].…”

Section: Data Collected By the Office For National Statisticsmentioning

confidence: 99%