Year: 2023
Type: article
Study design: Observational Study
Abstract: Background Nitrous oxide (N2O) 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 N2O recreationally, but most information comes from small case series. Methods We describe 119 patients with N2O-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 N2O canisters consumed per week correlated with methylmalonic acid levels in the blood as a measure of functional B12deficiency (rho (ρ)=0.44, p=0.04). Conclusions Preventable neurological harm from N2O abuse is increasingly seen worldwide. Ease of access to canisters and larger cylinders of N2O has led to an apparent rise in cases of N2O-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.
Authors: Devan Mair, Alvar Paris, Safiya A Zaloum, Laura M White, Katherine C Dodd, Christina Englezou, Farhin Patel, Siraj Abualnaja, James B Lilleker, David Gosal, Tom Hayton, Di Liang, Holger Allroggen, Mark Pucci, Stephen Keddie, Alastair J Noyce
Institutions: Queen Mary University of London, Barts Health NHS Trust, Northern Care Alliance NHS Foundation Trust, University of Manchester, University Hospitals Birmingham NHS Foundation Trust, The Royal Wolverhampton NHS Trust, University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funder: Barts Charity
Award: G6579178073
OpenAlex ID: W4378782143