Recreational nitrous oxide abuse related subacute combined degeneration of the spinal cord in adolescents – A case series and literature review

Lan, Shih-Yun; Kuo, Cheng-Yen; Chou, Cheng-Che; Kong, Shu-Sing; Hung, Po-Cheng; Tsai, Hsinyu; Chen, Yi-Ching; Lin, Jainn-Jim; Chou, I-Jun; Lin, Kuang-Lin

doi:10.1016/j.braindev.2018.12.003

Cited by 65 publications

(67 citation statements)

References 31 publications

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“…Patients presenting with N 2 O‐induced SCD typically have a history of regular N 2 O abuse for several months. Neurological symptoms most commonly include paresthesia of the limbs, diminished proprioception and vibration sensation, ataxia, and later muscle weakness . Autonomic dysfunction and cognitive impairment may also be present .…”

Section: Introductionmentioning

confidence: 99%

“…Neurological symptoms most commonly include paresthesia of the limbs, diminished proprioception and vibration sensation, ataxia, and later muscle weakness . Autonomic dysfunction and cognitive impairment may also be present . Other causes of vitamin B12 deficiency including impaired gastrointestinal absorption, pancreatic insufficiency, malnutrition, and intrinsic factor deficiency can make patients more susceptible to SCD in the setting of N 2 O use either for medical procedures or with recreational abuse …”

Section: Introductionmentioning

confidence: 99%

“…Vitamin B12 converts methylmalonyl coenzyme A to succinyl coenzyme A and homocysteine to methionine, which are important for myelin synthesis. Nitrous oxide causes permanent oxidation of cobalt ions in vitamin B12 inhibiting this conversion and decreasing availability of functional vitamin B12, although measured vitamin B12 levels may not reflect this functional deficiency, particularly in adolescents . Patients may have normal to low vitamin B12 levels, but methylmalonic acid and/or homocysteine levels are typically elevated and provide a more effective method to diagnose or screen for functional B12 deficiency .…”

Section: Introductionmentioning

confidence: 99%

“…Patients may have normal to low vitamin B12 levels, but methylmalonic acid and/or homocysteine levels are typically elevated and provide a more effective method to diagnose or screen for functional B12 deficiency . Inactivation of vitamin B12 ultimately leads to swelling of myelin sheaths and patchy myelopathic spongy vacuolation with demyelination, axonal swelling, and eventually axonal death …”

Section: Introductionmentioning

confidence: 99%

“…The prognosis is variable and may be slow with partial to full recovery . Factors associated with favorable prognosis include younger age, less severe neurological deficits, less extensive spinal cord lesions on magnetic resonance imaging (MRI), absence of anemia, and early treatment …”

Section: Introductionmentioning

confidence: 99%

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Subacute Combined Degeneration from Nitrous Oxide Abuse

Mogensen

Fink

2020

PM&R

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Subacute Combined Degeneration from Nitrous Oxide Abuse

Mogensen

Fink

2020

PM&R

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Nitrous oxide‐related neurological disorders: Clinical, laboratory, neuroimaging, and electrophysiological findings

et al. 2021

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Background: Recreational N 2 O abuse is an important etiology of neurological impairment in young patients, which may easily be ignored clinically. Few current studies have investigated the characteristics or the effects experienced by its users. We aimed to explore any correlation between the clinical severity and biomarkers and spinal magnetic resonance imaging (MRI) abnormalities, identify independent factors associated with spinal MRI abnormalities, and ascertain factors affecting depression/anxiety in patients with N 2 O-related neurological disorders.Methods: Patients with N 2 O-related neurological disorders were enrolled retrospectively between February 2017 and July 2020. Their demographic, clinical, laboratory, neuroimaging, electrophysiological, and neuropsychological findings were analyzed.Correlation analyses were conducted using Spearman's or Pearson's correlation and linear regression analysis. Independent factors associated with spinal MRI abnormalities were identified using univariate and multivariate analyses. Results:The principal clinical manifestations of N 2 O-related neurological disorders (n = 63; 38 men, 25 women; mean age ± SD: 22.60 ± 4.46 years) were sensory disturbance, followed by gait disturbance and pyramidal tract damage. A significant negative correlation existed between serum vitamin B 12 levels and clinical severity (r = −0.309, p = .014), which disappeared after linear regression. An interval of less than 6 months between initial N 2 O abuse and hospitalization was independently associated with spinal MRI abnormalities (39.47% vs. 72.00%, respectively; χ 2 = 6.40, p = .01). Thirtyeight (60.32%) and 40 (63.49%) patients experienced anxiety and depression, respectively. Moreover, the higher the clinical scores/serum homocysteine levels, the greater the severity of anxiety/depression (r = 0.442, p < .01; r = 0.346, p < .01; r = 0.477, p < .01; r = 0.324, p < .01). Conclusions:The significant inverse correlation between initial vitamin B 12 levels and clinical severity could aid prognosis prediction in patients with N 2 O-related neurological disorders. Spinal MRI abnormalities were not related to clinical severity butThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Clinical epidemiological characteristics of nitrous oxide abusers: A single‐center experience in a hospital in China

Dong

et al. 2021

Brain and Behavior

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This study investigated the clinical epidemiological characteristics of nitrous oxide (N 2 O) abusers in a hospital in China, which have not been systematically reported. Methods:The characteristics of patients abusing N 2 O who were examined and treated at the Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2020 were analyzed.Results: A total of 61 patients (average age: 21.7 ± 3.2 years; 42 male and 19 female) were enrolled; 60.7% of the patients had an education level of high school or lower, and most (59.0%) had no stable occupation. The mean exposure time was 8.5 ± 7.7 months (range: 1-36 months). Only 52.5% of the abusers reported the physician of the relevant exposure history at the first time of visiting the doctor. The main clinical type was mixed (49.2%). The most common clinical manifestation was distal limb numbness (80.3%).The most frequent outcome was peripheral neuropathy (59%) and subacute combined degeneration (36%). Serum homocysteine level was elevated in 67.5% (27/40) of the patients, while 44.4% (20/45) showed reduced vitamin B12. Note that 61% (22/36) showed abnormal signals in the posterior or lateral funiculus of the spinal cord, and 97% (31/32) of the patients showed peripheral nerve damage by electromyography. In all cases, symptoms were alleviated after halting N 2 O intake and receiving nutritional neurotherapy.Conclusions: N 2 O abuse can lead to nervous system damage, especially peripheral nerve and spinal cord damage. A full understanding of its clinical epidemiological characteristics is helpful for clinicians to make a timely and clear diagnosis.

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Recreational nitrous oxide abuse related subacute combined degeneration of the spinal cord in adolescents – A case series and literature review

Cited by 65 publications

References 31 publications

Subacute Combined Degeneration from Nitrous Oxide Abuse

Subacute Combined Degeneration from Nitrous Oxide Abuse

Nitrous oxide‐related neurological disorders: Clinical, laboratory, neuroimaging, and electrophysiological findings

Clinical epidemiological characteristics of nitrous oxide abusers: A single‐center experience in a hospital in China

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