Home > Nitrous oxide-induced myeloneuropathy: a case series.

Mair, Devan and Paris, Alvar and Zaloum, Safiya A and White, Laura M and Dodd, Katherine C and Englezou, Christina and Patel, Farhin and Abualnaja, Siraj and Lilleker, James B and Gosal, David and Hayton, Tom and Liang, Di and Allroggen, Holger and Pucci, Mark and Keddie, Stephen and Noyce, Alastair J (2023) Nitrous oxide-induced myeloneuropathy: a case series. Journal of Neurology, Neurosurgery, and Psychiatry, 94, (4), pp. 681-688. doi: 10.1136/jnnp-2023-331131.

External website: https://jnnp.bmj.com/content/early/2023/04/25/jnnp...

BACKGROUND: Nitrous oxide (NO) is the second most common recreational drug used by 16- to 24-year-olds in the UK. Neurological symptoms can occur in some people that use NO recreationally, but most information comes from small case series.

METHODS: We describe 119 patients with NO-myeloneuropathy seen at NHS teaching hospitals in three of the UK's largest cities: London, Birmingham and Manchester. This work summarises the clinical and investigative findings in the largest case series to date.

RESULTS: Paraesthesia was the presenting complaint in 85% of cases, with the lower limbs more commonly affected than the upper limbs. Gait ataxia was common, and bladder and bowel disturbance were frequent additional symptoms. The mid-cervical region of the spinal cord (C3-C5) was most often affected on MRI T2-weighted imaging. The number of NO canisters consumed per week correlated with methylmalonic acid levels in the blood as a measure of functional B deficiency (rho (ρ)=0.44, p=0.04).

CONCLUSIONS: Preventable neurological harm from NO abuse is increasingly seen worldwide. Ease of access to canisters and larger cylinders of NO has led to an apparent rise in cases of NO-myeloneuropathy in several areas of the UK. Our results highlight the range of clinical manifestations in a large group of patients to improve awareness of risk, aid early recognition, and promote timely treatment.

Item Type
Publication Type
International, Open Access, Article
Drug Type
Inhalents and solvents
Intervention Type
Harm reduction
Identification #
doi: 10.1136/jnnp-2023-331131
Page Range
pp. 681-688
BMJ Publishing

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