Journal
JOURNAL OF THE NEUROLOGICAL SCIENCES
Volume 414, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.jns.2020.116817
Keywords
B12 deficiency; Behavioral disorder; Clinical neurology; Myelin; Neuropsychiatry
Categories
Ask authors/readers for more resources
Background: Recreational use of nitrous oxide (NO) in the general public has led to increasing reports of NO-induced demyelination (NOID). We describe the varying clinical presentations and pathophysiology, and offer a treatment paradigm. Methods: A literature search of MEDLINE and EMBASE resulted in 42 publications with 37 studies meeting the inclusion criteria, for a total of 51 patients. Our case series included 5 patients seen from 2014 to 2018 followed over 3-60 months. Results: Those with sensory symptoms and subjective weakness were categorized as having mild symptoms (25%). Symptoms indicating involvement outside the dorsal columns such as observer-graded weakness were categorized as moderate (61%). Patients with the aforementioned plus cognitive effects were categorized as severe (12%). There was no dose-dependent relationship between the amount of NO used and clinical impairment. There was a trend between the severity of neurologic impairment and serum levels of B12. Two patients were noncompliant. One initiated only oral therapy and did not improve. One received injections a month apart and worsened. Conclusions: Patients with NOID tend to have worse symptoms when presenting with lower serum vitamin B12 levels and have good recovery rates when treated with intramuscular B12 and oral supplementation.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available