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

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

doi:10.1136/pn-2022-003631

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

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

^*Corresponding author for this work

Division of Musculoskeletal & Dermatological Sciences (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

Recreational use of nitrous oxide (N 2 O) has increased rapidly in recent years and is now the second most commonly used recreational drug among young people in the UK. There has been a corresponding rise in cases of nitrous oxide-induced subacute combined degeneration of the cord (N 2 O-SACD), a pattern of myeloneuropathy usually associated with severe vitamin B 12 deficiency. This can cause serious and permanent disability in young people but, if recognised early, may be effectively treated. All neurologists should be aware of N 2 O-SACD and its treatment; however, there are currently no agreed guidelines. Based on our experience in East London, an area of high N 2 O use, we provide practical advice on its recognition, investigation and treatment.

Original language	English
Pages (from-to)	222-228
Number of pages	7
Journal	Practical Neurology
Volume	23
Issue number	3
Early online date	22 Feb 2023
DOIs	https://doi.org/10.1136/pn-2022-003631
Publication status	Published - 1 Jun 2023

Keywords

B12 DEFICIENCY
CLINICAL NEUROLOGY
GAIT
MYELOPATHY
NEUROTOXICOLOGY
Magnetic Resonance Imaging
Subacute Combined Degeneration/diagnosis
Humans
Vitamin B 12/therapeutic use
Adolescent
Vitamin B 12 Deficiency/chemically induced
Nitrous Oxide/adverse effects

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10.1136/pn-2022-003631Licence: CC BY-NC

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title = "Nitrous oxide-induced subacute combined degeneration of the cord: Diagnosis and treatment",

abstract = "Recreational use of nitrous oxide (N 2 O) has increased rapidly in recent years and is now the second most commonly used recreational drug among young people in the UK. There has been a corresponding rise in cases of nitrous oxide-induced subacute combined degeneration of the cord (N 2 O-SACD), a pattern of myeloneuropathy usually associated with severe vitamin B 12 deficiency. This can cause serious and permanent disability in young people but, if recognised early, may be effectively treated. All neurologists should be aware of N 2 O-SACD and its treatment; however, there are currently no agreed guidelines. Based on our experience in East London, an area of high N 2 O use, we provide practical advice on its recognition, investigation and treatment.",

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author = "Alvar Paris and Luke Lake and Albert Joseph and Anna Workman and Joseph Walton and Tom Hayton and Nikos Evangelou and Lilleker, {James B.} and Ayling, {Ruth M.} and David Nicholl and Noyce, {Alastair J.}",

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AU - Paris, Alvar

AU - Lake, Luke

AU - Joseph, Albert

AU - Workman, Anna

AU - Walton, Joseph

AU - Hayton, Tom

AU - Evangelou, Nikos

AU - Lilleker, James B.

AU - Ayling, Ruth M.

AU - Nicholl, David

AU - Noyce, Alastair J.

PY - 2023/6/1

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KW - GAIT

KW - MYELOPATHY

KW - NEUROTOXICOLOGY

KW - Magnetic Resonance Imaging

KW - Subacute Combined Degeneration/diagnosis

KW - Humans

KW - Vitamin B 12/therapeutic use

KW - Adolescent

KW - Vitamin B 12 Deficiency/chemically induced

KW - Nitrous Oxide/adverse effects

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JO - Practical Neurology

JF - Practical Neurology

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ER -

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

Abstract

Keywords

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