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Mohammed H, Sara E, Bouchra O. Acute psychotic and vitamin B12 deficiency in patient with nitrous oxide misuse: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241269577. [PMID: 39131582 PMCID: PMC11311192 DOI: 10.1177/2050313x241269577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/25/2024] [Indexed: 08/13/2024] Open
Abstract
Nitrous oxide, also called nitrous monoxide, or nitrous oxide, is a colorless and odorless gas, without toxicological effect, but it can be asphyxiating at high concentration, its misuse is increasing especially among young people. Chronic use of N2O may cause psychiatric complications, including depression, hypomania, and paranoid psychosis with visual and auditory hallucinations. We present a case of nitrous oxide abuse "laughing gas" in 25 years old woman with bizarre behavior delusions and hallucinations with a normal neurological examination. The patient had low levels of vitamin B12 (135 pmol/L). Treatment with antipsychotics and vitamin B12 (cobalamin) resolved her psychosis. In addition to the hematological and neurological effects, rare cases of acute psychosis, especially in young people with or without psychiatric history, use varies from 1 month to years. Clinicians are increasingly in need of knowledge regarding the misuse of nitrous oxide.
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Affiliation(s)
- Hasnaoui Mohammed
- Department of Psychiatry, University Hospital of Mohammed VI-Oujda, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Echater Sara
- Department of Psychiatry, University Hospital of Mohammed VI-Oujda, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Psychiatry Department, Faculty of Medicine and Pharmacy of Tangier, Université Abdelmalek Essaadi, CHU Mohammed VI, Tangier, Morocco
| | - Oneib Bouchra
- Department of Psychiatry, University Hospital of Mohammed VI-Oujda, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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2
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Yap LE, Nutakki A, Regmi N, Dawson ET, Raza R, Haas CJ. Nitrous Oxide in an Acute Inflammatory Demyelinating Polyneuropathy-Like Presentation. Mayo Clin Proc 2024; 99:1345-1346. [PMID: 39097340 DOI: 10.1016/j.mayocp.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 08/05/2024]
Affiliation(s)
- Lauren E Yap
- Georgetown University School of Medicine, Washington, DC
| | - Aparna Nutakki
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Nripesh Regmi
- Department of Hospital Medicine, MedStar Harbor Hospital, Baltimore, MD
| | - Elliot T Dawson
- Department of Neurology, MedStar Franklin Square Medical Center, Baltimore, MD
| | - Rafi Raza
- Department of Radiology, MedStar Franklin Square Medical Center, Baltimore, MD
| | - Christopher J Haas
- Department of Internal Medicine, Georgetown University School of Medicine, Washington, DC
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3
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Blom JD. Hallucinations and Vitamin B12 Deficiency: A Systematic Review. Psychopathology 2024:1-12. [PMID: 39047712 DOI: 10.1159/000540003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 06/17/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Vitamin B12 deficiency is primarily associated with pernicious anaemia, polyneuropathy, and spinal-cord disease, but publications on its association with hallucinations are on the rise. METHODS I carried out a systematic literature search on these hallucinations in PubMed, PsycINFO, and Google Scholar, up until July 1, 2023. RESULTS The search yielded 50 case studies published between 1960 and 2023. The hallucinations described therein are predominantly visual and/or auditory in nature, with 20% being specified as complex, compound, or panoramic. They are often described in the context of vitamin B12-related neuropsychiatric conditions such as dementia, delirium, epilepsy, psychotic disorder, schizoaffective disorder, bipolar disorder, depressive disorder, catatonia, or obsessive-compulsive disorder. In the context of such disorders, they tend to appear first and also often appear to be the first to disappear with cobalamin treatment. Within an average of 2 months, full amelioration was thus obtained in 75% of the cases and partial amelioration in the remaining 25%. Remarkably, a quarter of the cases involved therapy-resistant hallucinations that fully resolved under cobalamin monotherapy, while other neuropsychiatric manifestations of vitamin B12 deficiency disappeared in 60% of the treated cases. Only 32% of the cases involved comorbid pernicious anaemia. This suggests that two separate or diverging pathways exist for perceptual and haematological symptoms of vitamin B12 deficiency. CONCLUSION In the light of the high prevalence rate of vitamin B12 deficiency in the general population, the findings here presented should be interpreted with great caution. Nonetheless, they offer cues for further research and experimental application in clinical practice. This may be especially relevant in light of the recent increase in the popularity of vegetarianism and the recreational use of nitrous oxide (laughing gas), which are both risk factors for vitamin B12 deficiency.
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Affiliation(s)
- Jan Dirk Blom
- Outpatient Clinic for Uncommon Psychiatric Syndromes, Parnassia Psychiatric Institute, The Hague, The Netherlands
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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4
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Zhang Y, Xie J. Ferroptosis implication in environmental-induced neurotoxicity. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 934:172618. [PMID: 38663589 DOI: 10.1016/j.scitotenv.2024.172618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/12/2024] [Accepted: 04/17/2024] [Indexed: 05/24/2024]
Abstract
Neurotoxicity, stemming from exposure to various chemical, biological, and physical agents, poses a substantial threat to the intricate network of the human nervous system. This article explores the implications of ferroptosis, a regulated form of programmed cell death characterized by iron-dependent lipid peroxidation, in environmental-induced neurotoxicity. While apoptosis has historically been recognized as a primary mechanism in neurotoxic events, recent evidence suggests the involvement of additional pathways, including ferroptosis. The study aims to conduct a comprehensive review of the existing literature on ferroptosis induced by environmental neurotoxicity across diverse agents such as natural toxins, insecticides, particulate matter, acrylamide, nanoparticles, plastic materials, metal overload, viral infections, anesthetics, chemotherapy, and radiation. The primary objective is to elucidate the diverse mechanisms through which these agents trigger ferroptosis, leading to neuronal cell death. Furthermore, the article explores potential preventive or therapeutic strategies that could mitigate ferroptosis, offering insights into protective measures against neurological damage induced by environmental stressors. This comprehensive review contributes to our evolving understanding of neurotoxicological processes, highlighting ferroptosis as a significant contributor to neuronal cell demise induced by environmental exposures. The insights gained from this study may pave the way for the development of targeted interventions to protect against ferroptosis-mediated neurotoxicity and ultimately safeguard public health.
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Affiliation(s)
- Yiping Zhang
- School of Life Sciences, Fudan University, Shanghai 200438, China; Wanchuanhui (Shanghai) Medical Technology Co., Ltd, Shanghai 201501, China.
| | - Jun Xie
- School of Life Sciences, Fudan University, Shanghai 200438, China; Wanchuanhui (Shanghai) Medical Technology Co., Ltd, Shanghai 201501, China.
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5
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Xu X, Zhang L, He Y, Qi C, Li F. Progress in Research on the Role of the Thioredoxin System in Chemical Nerve Injury. TOXICS 2024; 12:510. [PMID: 39058162 PMCID: PMC11280602 DOI: 10.3390/toxics12070510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
(1) Background: Various factors, such as oxidative stress, mitochondrial dysfunction, tumors, inflammation, trauma, immune disorders, and neuronal toxicity, can cause nerve damage. Chemical nerve injury, which results from exposure to toxic chemicals, has garnered increasing research attention. The thioredoxin (Trx) system, comprising Trx, Trx reductase, nicotinamide adenine dinucleotide phosphate, and Trx-interacting protein (TXNIP; endogenous Trx inhibitor), helps maintain redox homeostasis in the central nervous system. The dysregulation of this system can cause dementia, cognitive impairment, nerve conduction disorders, movement disorders, and other neurological disorders. Thus, maintaining Trx system homeostasis is crucial for preventing or treating nerve damage. (2) Objective: In this review study, we explored factors influencing the homeostasis of the Trx system and the involvement of its homeostatic imbalance in chemical nerve injury. In addition, we investigated the therapeutic potential of the Trx system-targeting active substances against chemical nerve injury. (3) Conclusions: Chemicals such as morphine, metals, and methylglyoxal interfere with the activity of TXNIP, Trx, and Trx reductase, disrupting Trx system homeostasis by affecting the phosphatidylinositol-3-kinase/protein kinase B, extracellular signal-regulated kinase, and apoptotic signaling-regulated kinase 1/p38 mitogen-activated protein kinase pathways, thereby leading to neurological disorders. Active substances such as resveratrol and lysergic acid sulfide mitigate the symptoms of chemical nerve injury by regulating the Ras/Raf1/extracellular signal-regulated kinase pathway and the miR-146a-5p/TXNIP axis. This study may guide the development of Trx-targeting modulators for treating neurological disorders and chemical nerve injuries.
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Affiliation(s)
- Xinwei Xu
- School of Medicine, Jiangsu University, Zhenjiang 212013, China; (X.X.); (L.Z.); (Y.H.)
| | - Lan Zhang
- School of Medicine, Jiangsu University, Zhenjiang 212013, China; (X.X.); (L.Z.); (Y.H.)
| | - Yuyun He
- School of Medicine, Jiangsu University, Zhenjiang 212013, China; (X.X.); (L.Z.); (Y.H.)
| | - Cong Qi
- Department of Pharmacy, Jurong People’s Hospital, Jurong 212400, China;
| | - Fang Li
- School of Medicine, Jiangsu University, Zhenjiang 212013, China; (X.X.); (L.Z.); (Y.H.)
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6
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Li Z, Li Z, Qiang H, Xie W, Su M, Xiang P, Shi Y. Quantitative determination of nitrous oxide in human blood by HS-GC-MS: forensic application of two fatal poisoning cases. Forensic Sci Int 2024; 360:112067. [PMID: 38821023 DOI: 10.1016/j.forsciint.2024.112067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
Nitrous oxide (N2O), also known as laughing gas, has a euphoric effect and is becoming increasingly popular as a recreational inhalant drug. Deaths caused by recreational nitrous oxide abuse are rare, but may still occur. Although some methods for the quantification of N2O by GC-MS have been reported, elimination of carbon dioxide interference and the choice of a suitable internal standard remain current limitations to accurate N2O quantification. Here, a validated method using headspace-gas chromatography-mass spectrometry (HS-GC-MS) is described that allows the quantification of N2O in human blood samples: sodium hydroxide is used to remove carbon dioxide, and n-pentane is chosen as a suitable internal standard. Collectively, the validation results show a good linear relationship of N2O in blood within the concentration range of 0.02 ∼ 0.5 mL/mL and an LOD of 0.005 mL/mL. Subsequent application of the validated method to two real mortality cases due to N2O intoxication provided reference values for blood concentrations in forensic cases. Other biological specimens (gaseous samples and tissues) of the deceased were also analyzed to demonstrate that the deaths were caused by asphyxia due to the inhalation of N2O.
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Affiliation(s)
- Zehong Li
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China; School of Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Ziyi Li
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China; School of Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Huosheng Qiang
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China
| | - Wanting Xie
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China; School of Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Mengxiang Su
- School of Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Ping Xiang
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China.
| | - Yan Shi
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China.
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Ryder H, Mosalski S, Bramah V, Page R, Faux SG, Shiner CT. Multidisciplinary rehabilitation following recreational nitrous oxide (N 2O) misuse: evaluating service provision and rehabilitation outcomes in a cohort with serious disability. Disabil Rehabil 2024:1-10. [PMID: 38950561 DOI: 10.1080/09638288.2024.2365987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024]
Abstract
Purpose: Recreational nitrous oxide (N2O) misuse is increasing globally. Chronic misuse can cause neurological impairments that require rehabilitation, though literature characterising rehabilitation is limited. This study aimed to evaluate rehabilitation service provision for impairments resulting from N2O misuse. Methods: A retrospective audit of hospitalised patients referred for rehabilitation for N2O toxicity was conducted between 2015 and 2022 at a single metropolitan hospital. Data were collected via medical record audit and analysed via descriptive and non-parametric statistics. Results: 16 eligible cases were identified, aged 18-43 years (50% female/male), with increasing case frequency. 12 cases received inpatient rehabilitation episodes for multifactorial sensorimotor, cognitive and psychosocial impairments. Cases articulated diverse rehabilitation goals and received intervention from a median of 6 clinical disciplines. All cases required assistance to mobilise or perform self-care activities on admission. Functional Independence Measure (FIM) scores significantly improved with rehabilitation (median FIM 84[75-93] to 117[112-123], p < .001). Despite gains in independence, all cases required referral for ongoing rehabilitation post-discharge. Conclusions: Demand for inpatient rehabilitation for disabling N2O toxicity appears to be increasing. In this series, cases were young, exhibited serious impairments, and had multidisciplinary rehabilitation needs. Inpatient rehabilitation led to significant functional improvements, though ongoing disability was evident post-discharge.
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Affiliation(s)
- Hannah Ryder
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Simon Mosalski
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- School of Medicine, Sydney Campus, University of Notre Dame, Australia
| | - Valerie Bramah
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
| | - Robert Page
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- School of Medicine, Sydney Campus, University of Notre Dame, Australia
| | - Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
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8
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Dai Q, Chen S, Zhang X, Fan K, Zhang J, Zheng J. Nitrous oxide abuse in a 21-year-old female: a case report and review of literature. Front Neurol 2024; 15:1416557. [PMID: 38994489 PMCID: PMC11236749 DOI: 10.3389/fneur.2024.1416557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024] Open
Abstract
The abuse of nitrous oxide (N2O) poses a substantial public health challenge. In many countries, including China, regulations governing the utilization and accessibility to N2O remain ambiguous, particularly within the food industry. Here, we report a case of a 21-year-old female who presented with symptoms of subacute combined degeneration (SCD) of the spinal cord due to N2O abuse. The patient exhibited bilateral lower limb numbness and weakness, low serum vitamin B12 levels with elevated homocysteine levels, and lumbar spine magnetic resonance imaging (MRI) revealed abnormal signals of the spinal cord. Following cessation of N2O and comprehensive therapy including methylcobalamin and nerve growth factor, the symptoms significantly improved. A follow-up examination 3 months later showed good progress in gait stability. At a 5-year follow-up, the patient's previous clinical symptoms had completely disappeared, and her quality of life had returned to normal. This case underscores the urgency of raising awareness and prevention of N2O abuse, emphasizing the importance of timely diagnosis and comprehensive treatment for patient recovery. Clear formulation and enforcement of relevant regulatory measures are equally crucial in reducing instances of abuse.
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Affiliation(s)
- Qi Dai
- Department of Radiology, Ningbo No.2 Hospital, Ningbo, China
| | - Shutong Chen
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, China
| | - Xiaodan Zhang
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China
| | - Kuixin Fan
- Department of Emergency Medicine, Ningbo No.2 Hospital, Ningbo, China
| | - Jingfeng Zhang
- Department of Radiology, Ningbo No.2 Hospital, Ningbo, China
| | - Jianjun Zheng
- Department of Radiology, Ningbo No.2 Hospital, Ningbo, China
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9
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Dawudi Y, Azoyan L, Broucker TDE, Gendre T, Miloudi A, Echaniz-Laguna A, Mazoyer J, Zanin A, Kubis N, Dubessy AL, Gorza L, Ben Nasr H, Caré W, d'Izarny-Gargas T, Formoso A, Vilcu AM, Bonnan M. Marked increase in severe neurological disorders after nitrous oxide abuse: a retrospective study in the Greater Paris area. J Neurol 2024; 271:3340-3346. [PMID: 38478030 PMCID: PMC11136741 DOI: 10.1007/s00415-024-12264-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Recreational nitrous oxide (N2O) use has become more widespread worldwide, leading to an increase in myelopathies and peripheral neuropathies. The aim of this study was to describe clinical and socioeconomical characteristics of severe N2O-induced (NI) neurological disorders (NI-NDs), to determine its incidence in the Greater Paris area and to compare it with that of similar inflammatory neurological disorders. METHODS We performed a retrospective multicentric cohort study of all adult patients with severe NI-NDs in the neurology and general internal medicine departments of the Greater Paris area from 2018 to 2021. The incidence was compared with that of non-NI-myelitis and Guillain-Barré syndrome (GBS) using a sample of 91,000 hospitalized patients sourced from health insurance data. RESULTS Among 181 patients, 25% had myelopathy, 37% had peripheral neuropathy and 38% had mixed disease. Most were aged between 20 and 25 years, lived in socially disadvantaged urban areas, and exhibited high rates of unemployment (37%). The incidence of NI-NDs increased during 2020 and reached a peak mid-2021. The 2021 incidence in 20-25-year-olds was 6.15 [4.72; 8.24] per 100,000 persons for NI-myelopathy and 7.48 [5.59; 9.37] for NI-peripheral neuropathy. This was significantly higher than for non-NI-myelitis (0.35 [0.02; 2.00]) and GBS (2.47 [0.64; 4.30]). The incidence of NI-NDs was two to three times higher in the most socially disadvantaged areas. CONCLUSION The recent increase in recreational N2O use has led to a rise in the incidence of severe NI-NDs, particularly in young adults with low socioeconomic status for whom NI-NDs strongly outweigh similar neurological disorders.
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Affiliation(s)
- Yachar Dawudi
- Neurology Department, Centre Hospitalier de Saint-Denis, 2 Rue du Dr Delafontaine, 93200, Saint-Denis, France.
- Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136, Sorbonne Université INSERM, Paris, France.
| | - Loris Azoyan
- Neurology Department, Centre Hospitalier de Saint-Denis, 2 Rue du Dr Delafontaine, 93200, Saint-Denis, France
- Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136, Sorbonne Université INSERM, Paris, France
| | - Thomas D E Broucker
- Neurology Department, Centre Hospitalier de Saint-Denis, 2 Rue du Dr Delafontaine, 93200, Saint-Denis, France
| | - Thierry Gendre
- Neurology Department, Hôpital Henri-Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
| | - Amal Miloudi
- Neurology Department, Centre Hospitalier Intercommunal Robert Ballanger, Bd Robert Ballanger, 93600, Aulnay-Sous-Bois, France
| | - Andoni Echaniz-Laguna
- Neurology Department, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Julie Mazoyer
- Neurology Department, Hôpital Avicenne, 125 Route de Stalingrad, 93009, Bobigny, France
| | - Adrien Zanin
- Clinical Physiology Department, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Nathalie Kubis
- Clinical Physiology Department, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Anne-Laure Dubessy
- Neurology Department, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Lucas Gorza
- Neurology Department, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Haifa Ben Nasr
- Neurology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91100, Corbeil-Essonnes, France
| | - Weniko Caré
- Department of Internal Medicine, Bégin Military Teaching Hospital, Saint-Mandé, France
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP, Paris, France
| | | | - Aude Formoso
- Neurology Department, Hôpital de La Pitié Salpêtrière, 47-83 Bd de L'Hôpital, 75013, Paris, France
| | - Ana-Maria Vilcu
- Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136, Sorbonne Université INSERM, Paris, France
| | - Mickael Bonnan
- Neurology Department, Centre Hospitalier de Saint-Denis, 2 Rue du Dr Delafontaine, 93200, Saint-Denis, France
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10
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Xu Y, Xin X, Tao T. Decoding the neurotoxic effects of propofol: insights into the RARα-Snhg1-Bdnf regulatory cascade. Am J Physiol Cell Physiol 2024; 326:C1735-C1752. [PMID: 38618701 PMCID: PMC11371332 DOI: 10.1152/ajpcell.00547.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/26/2023] [Accepted: 01/27/2024] [Indexed: 04/16/2024]
Abstract
The potential neurotoxic effects of propofol, an extensively utilized anesthetic, underline the urgency to comprehend its influence on neuronal health. Insights into the role of the retinoic acid receptor-α, small nucleolar RNA host gene 1, and brain-derived neurotrophic factor (RARα-Snhg1-Bdnf) network can offer significant advancements in minimizing these effects. The study targets the exploration of the RARα and Snhg1 regulatory network's influence on Bdnf expression in the realm of propofol-induced neurotoxicity. Harnessing the Gene Expression Omnibus (GEO) database and utilizing JASPAR and RNA-Protein Interaction Prediction (RPISeq) database for projections, the study embarks on an in-depth analysis employing both in vitro and in vivo models. The findings draw a clear link between propofol-induced neurotoxicity and the amplification of RAR signaling pathways, impacting hippocampal development and apoptosis and leading to increased RARα and Snhg1 and decreased Bdnf. Propofol is inferred to accentuate neurotoxicity by heightening RARα and Snhg1 interactions, culminating in Bdnf suppression.NEW & NOTEWORTHY This study aimed to decode propofol's neurotoxic effects on the regulatory cascade, provide insights into the RARα-Snhg1-Bdnf interaction, apply extensive validation techniques, provide a detailed analysis and exploration of propofol's neurotoxicity, and offer a comprehensive approach to understanding molecular interactions.
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Affiliation(s)
- Yuhai Xu
- Department of Anesthesiology, Air Force Medical Center, Beijing, People's Republic of China
| | - Xin Xin
- Department of Anesthesiology, Air Force Medical Center, Beijing, People's Republic of China
| | - Tianzhu Tao
- Department of Anesthesiology, Air Force Medical Center, Beijing, People's Republic of China
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11
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Delsanti R, Arnaud C, Defer G. Neurological disorders related to recreational nitrous oxide abuse: Two sides of the same coin. Rev Neurol (Paris) 2024; 180:467-469. [PMID: 38052664 DOI: 10.1016/j.neurol.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/07/2023] [Accepted: 10/10/2023] [Indexed: 12/07/2023]
Affiliation(s)
- R Delsanti
- Department of Neurology, CHU of Caen Normandie, avenue de la Côte-de-Nacre, 14000 Caen, France; Normandie University, UNICAEN, UFR de médecine, 14000 Caen, France.
| | - C Arnaud
- Department of Neurology, CHU of Caen Normandie, avenue de la Côte-de-Nacre, 14000 Caen, France; Normandie University, UNICAEN, UFR de médecine, 14000 Caen, France
| | - G Defer
- Department of Neurology, CHU of Caen Normandie, avenue de la Côte-de-Nacre, 14000 Caen, France; Normandie University, UNICAEN, UFR de médecine, 14000 Caen, France; UMR-S1237, Physiopathology and Imaging of Neurological Disorders, Inserm, Caen, France
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12
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Patel S, Winder GS. New-Onset Nitrous Oxide "Whippet" Use Following Liver Transplantation. J Acad Consult Liaison Psychiatry 2024; 65:216-217. [PMID: 38142863 DOI: 10.1016/j.jaclp.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Shivali Patel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI.
| | - Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Neurology, University of Michigan, Ann Arbor, MI
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13
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Ruijter BJ, de Mooij MJ, Bruijnes JE, van Oosterhout WPJ, Kwa VIH. Neurological complications of excessive recreational nitrous oxide use: a case series based on a text mining algorithm. J Neurol 2024; 271:1267-1276. [PMID: 37914912 DOI: 10.1007/s00415-023-12061-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The recreational use of nitrous oxide (N2O) has gained popularity over recent years. We present a case series of excessive N2O users with neurological complications. METHODS In this retrospective three-centre study, we used a text mining algorithm to search for patients who used N2O recreationally and visited a neurologist. RESULTS We identified 251 patients. The median duration of N2O use was 11 months (interquartile range [IQR], 3-24) and the median amount of N2O used per occasion 1.6 kg (IQR 0.5-4.0). Clinically, polyneuropathy (78%), myelopathy (41%), and encephalopathy (14%) were the most common diagnoses. An absolute vitamin B12 deficiency of < 150 pmol/L was found in 40% of cases. In 90%, at least one indicator of functional vitamin B12 status (vitamin B12, homocysteine, or methylmalonic acid) was abnormal. MRI showed signs of myelopathy in 30/55 (55%) of cases. In 28/44 (64%) of those who underwent electromyography, evidence of axonal polyneuropathy was found. Most (83%) patients were treated with vitamin B12 supplementation, and 23% were admitted to the hospital. Only 41% had follow-up for ≥ 30 days, and 79% of those showed partial or complete recovery. CONCLUSIONS In this case series of excessive N2O users, we describe a high prevalence of polyneuropathy, myelopathy, and encephalopathy. Stepwise testing for serum levels of vitamin B12, homocysteine, and methylmalonic acid may support the clinical diagnosis. Due to low sensitivity, MRI of the spinal cord and electromyography have limited value. Effective treatment should incorporate supplementation of vitamin B12 and strategies to prevent relapses in N2O use.
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Affiliation(s)
- B J Ruijter
- Department of Neurology, OLVG, Amsterdam, the Netherlands.
| | - M J de Mooij
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - J E Bruijnes
- Department of Neurology, Zuyderland Medical Centre, Heerlen, the Netherlands
- Department of Neurology, Maastricht UMC+, Maastricht, the Netherlands
| | | | - V I H Kwa
- Department of Neurology, OLVG, Amsterdam, the Netherlands
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14
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Murray BP, Kiernan EA. Physiologic Effects of Substance Use. Emerg Med Clin North Am 2024; 42:69-91. [PMID: 37977754 DOI: 10.1016/j.emc.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Physiologic and psychological effects of substance use are common occurrences. They may be the proximate purpose of the exposure or related to an unintended complication. Acute short-term exposure effects may not be the same as long-term effects. These effects are mediated by different receptors they act on and the homeostatic changes that occur due to repeat exposure. We review in this article the physiologic and psychological effects from exposure to commonly encountered drugs, ethanol, sedative hypnotics, cocaine, amphetamines, marijuana, opioids, nicotine, hydrocarbons (halogenated and non-halogenated), and nitrous oxide.
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Affiliation(s)
- Brian Patrick Murray
- Department of Emergency Medicine, Wright State Boonshoft School of Medicine, 2555 University Boulevard, Suite 110, Dayton, OH 45324, USA.
| | - Emily Anne Kiernan
- Department of Emergency Medicine, Emory University School of Medicine, 50 Hurtz Plaza Southeast, Suite 600, Atlanta, GA, USA; Georgia Poison Center, 50 Hurtz Plaza Southeast, Suite 600, Atlanta, GA, USA
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15
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Jolobe OMP. Nitrous oxide myeloneuropathy as the differential diagnosis of Guillain-Barre syndrome. Am J Emerg Med 2024; 76:231-232. [PMID: 38000986 DOI: 10.1016/j.ajem.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Affiliation(s)
- Oscar M P Jolobe
- British Medical Association, BMA House, Tavistock Square, London WC1H 9JP, UK.
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16
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Gardin TM, Yang A, Moeller JJ, Quraishi IH. Subacute combined degeneration of the spinal cord in a patient with nitrous oxide use and autoimmune atrophic gastritis. BMJ Case Rep 2023; 16:e254727. [PMID: 38035681 PMCID: PMC10689362 DOI: 10.1136/bcr-2023-254727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/02/2023] Open
Abstract
Nitrous oxide is among the most common drugs used by adolescents and young adults, and its neuropsychiatric sequelae are severe but reversible with timely treatment. The causal mechanism relates to impaired metabolism of vitamin B12, which is necessary for the development and maintenance of the myelin sheath. Individuals most susceptible to neuropsychiatric manifestations are those with a secondary cause of vitamin B12 deficiency, including nutritional deficiency and impaired absorption, or an alternative cause of impaired metaboclism. We describe the case of a man in his thirties who developed subacute combined degeneration of the spinal cord and polyneuropathy in the setting of recreational nitrous oxide use and autoimmune atrophic gastritis. Our case highlights clinical pearls for diagnosis and treatment, differential diagnosis, common concomitant aetiologies and the importance of screening for substance use disorder and psychiatric comorbidities.
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Affiliation(s)
| | - Annie Yang
- Neurology, Yale School of Medicine, New Haven, Connecticut, USA
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17
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Wu H, Xu L, Zheng X, Zhou X, Zhang Y, Sun Y. Neuropsychiatric disorders associated with recreational nitrous oxide use. Clin Toxicol (Phila) 2023; 61:961-967. [PMID: 37999959 DOI: 10.1080/15563650.2023.2279936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Recreational nitrous oxide use has grown in popularity among young people and has become a serious public health problem. Chronic use of nitrous oxide can lead to a functional vitamin B12 deficiency and neuropsychiatric complications. PURPOSE This study aimed to investigate the characteristics of neuropsychiatric complications associated with nitrous oxide use and to enhance clinicians' awareness of this public health problem. METHODS We retrospectively reviewed 16 patients with neuropsychiatric disorders related to nitrous oxide use who were treated in our hospital from June 2021 to October 2022. Their demographics, clinical features, investigations, treatments and outcomes were analyzed. RESULTS There were ten males and six females between the ages of 17 and 25 with a mean age of 20.5 ± 2.6 years. Thirteen patients sought medical help from the neurology clinic. Two patients presented to the psychiatric department and one patient presented to the emergency department with acute cognitive impairment. All 16 patients presented with neurological symptoms, such as paresthesia in four limbs or the lower limbs, unsteady gait and weakness. Twelve patients developed psychiatric symptoms, such as hallucinations, agitation, depression, emotional indifference and personality changes. Twelve patients had vitamin B12 deficiency. All 16 patients had hyperhomocysteinemia. Fourteen patients showed abnormal high signal on T2-weighted imaging and an inverted "V" sign in axial view, mainly involving the cervical cord. Neuropsychiatric symptoms improved with vitamin B12 treatment and cessation of nitrous oxide use in all cases. CONCLUSION Young adults are predominately involved in recreational use of nitrous oxide, which can cause neuropsychiatric complications. The clinical response to vitamin B12 supplementation and cessation of nitrous oxide use is generally good. Clinicians should recognize nitrous oxide use as a public health problem and a cause of a wide range of neuropsychiatric symptoms, particularly in younger patients.
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Affiliation(s)
- Huijuan Wu
- Jinzhou Medical University, Jinzhou, China
| | - Liaoyang Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xingyongpei Zheng
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xinyu Zhou
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Yongjin Zhang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- Department of Neurology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
| | - Yong Sun
- Department of Neurosurgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- Department of Neurosurgery, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, China
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18
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Riccò M, Ferraro P, Corrado S, Bottazzoli M, Marchesi F. Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1820. [PMID: 37893538 PMCID: PMC10608448 DOI: 10.3390/medicina59101820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/24/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Nitrous oxide (N2O) has recently emerged as a cheap alternative to other recreational substances. Although legally available, its chronic use is associated with severe neurological and hematological complications due to the irreversible inactivation of vitamin B12. While no reliable data on abuse of N2O in Italy have been provided to date, we assessed the knowledge, attitudes, and practices of Italian medical professionals on the management of N2O abuse cases. Materials and Methods: A cross-sectional study was performed as a web-based survey through a series of Facebook discussion groups (targeted medical professionals: 12,103), and participants were specifically asked about their previous understanding of N2O abuse and whether they had or not any previous experience in this topic. Results: A total 396 medical professionals participated in the survey. Overall, 115 participants had previous knowledge about N2O abuse (29.04%), with higher odds for professionals with a background in emergency medicine (adjusted odds ratio (aOR) 3.075; 95% confidence intervals (95%CI) 1.071 to 8.828) and lower for specialists in psychiatry (aOR 0.328; 95%CI 0.130 to 0.825). Knowledge status on N2O abuse was largely unsatisfying, as knowledge status, reported as a percent value, was estimated to 45.33% ± 24.71. Having previously managed a case of N2O abuse was associated with higher risk perception of the actual severity of this condition (aOR 5.070; 95%CI 1.520 to 16.980). Conclusions: Our study suggests that N2O poisoning cases are occurring in Italian settings but are not reasonably reported to national authorities. As substantial knowledge gaps of Italian medical workforces were identified, we cannot rule out that the actual abuse of N2O in the population may be far larger than currently suspected.
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Affiliation(s)
- Matteo Riccò
- Occupational Health and Safety Service on the Workplace/Servizio di Prevenzione e Sicurezza Ambienti di Lavoro (SPSAL), Department of Public Health, AUSL–IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Pietro Ferraro
- Occupational Medicine Unit, Direzione Sanità, Italian Railways’ Infrastructure Division, RFI SpA, 00161 Rome, Italy;
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della donna e Area Materno-Infantile, UOC Pediatria, 20024 Garbagnate Milanese, Italy;
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 31223 Trento, Italy;
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
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19
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DiPane J, Tiem M, Wright BA, Qayoumi W, Coughlin DG. Nitrous Oxide Toxicity With Subsequent Recovery. Neurology 2023; 101:674-675. [PMID: 37487745 PMCID: PMC10585688 DOI: 10.1212/wnl.0000000000207603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/16/2023] [Indexed: 07/26/2023] Open
Affiliation(s)
- Joseph DiPane
- From the University of California San Diego School of Medicine (J.D.); and Department of Neurosciences (M.T., B.A.W., W.Q., D.G.C.), University of California San Diego, La Jolla
| | - Michelle Tiem
- From the University of California San Diego School of Medicine (J.D.); and Department of Neurosciences (M.T., B.A.W., W.Q., D.G.C.), University of California San Diego, La Jolla
| | - Brenton A Wright
- From the University of California San Diego School of Medicine (J.D.); and Department of Neurosciences (M.T., B.A.W., W.Q., D.G.C.), University of California San Diego, La Jolla
| | - Wali Qayoumi
- From the University of California San Diego School of Medicine (J.D.); and Department of Neurosciences (M.T., B.A.W., W.Q., D.G.C.), University of California San Diego, La Jolla
| | - David G Coughlin
- From the University of California San Diego School of Medicine (J.D.); and Department of Neurosciences (M.T., B.A.W., W.Q., D.G.C.), University of California San Diego, La Jolla.
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20
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Corrêa DG, da Cruz LCH, da Rocha AJ, Pacheco FT. Imaging Aspects of Toxic and Metabolic Myelopathies. Semin Ultrasound CT MR 2023; 44:452-463. [PMID: 37555682 DOI: 10.1053/j.sult.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Metabolic and toxic myelopathies usually occurs due to several different causes. Metabolic myelopathy usually occurs due to deficiency of a nutrient, such as vitamin B12. Toxic myelopathy occurs secondary to the exposure to an external toxic agent. Although they may have a difficult diagnosis, determination of the specific cause of myelopathy is of utmost importance, because many causes are amenable to treatment. Although they have many clinical, electrophysiologic, and neuropathologic similarities, imaging may aid in the suspicion of toxic or metabolic myelopathy. The aim of this article, is to review the imaging features of the main toxic and metabolic myelopathies.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil; Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
| | | | - Antônio José da Rocha
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Felipe Torres Pacheco
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
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21
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Meißner JN, Hill K, Lakghomi A, Nitsch L. [Inhaled nitrous oxide-induced subacute combined degeneration-A differential diagnosis of Guillain-Barré syndrome]. DER NERVENARZT 2023; 94:951-955. [PMID: 36799957 PMCID: PMC10575797 DOI: 10.1007/s00115-023-01443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 02/18/2023]
Affiliation(s)
- Julius N Meißner
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| | - Katharina Hill
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Asadeh Lakghomi
- Klinik für Neuroradiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Louisa Nitsch
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
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22
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Vitte T, Castrioto A, Schmitt E, Moro E, Potel SR. Subacute cognitive impairment in B12 vitamin-deficiency neuromyelopathy secondary to nitrous oxide abuse. Neurol Sci 2023; 44:3341-3343. [PMID: 37133686 DOI: 10.1007/s10072-023-06813-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Affiliation(s)
- Timour Vitte
- Division of Neurology, Grenoble University Hospital, Grenoble, France
| | - Anna Castrioto
- Division of Neurology, Grenoble Institute of Neurosciences, Grenoble Alpes University, Grenoble University Hospital, Grenoble, France
| | - Emmanuelle Schmitt
- Division of Neurology, Grenoble Institute of Neurosciences, Grenoble Alpes University, Grenoble University Hospital, Grenoble, France
| | - Elena Moro
- Division of Neurology, Grenoble Institute of Neurosciences, Grenoble Alpes University, Grenoble University Hospital, Grenoble, France
| | - Sina R Potel
- Division of Neurology, Grenoble University Hospital, Grenoble, France.
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23
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Deng L, Wu L, Gao R, Xu X, Chen C, Liu J. Non-Opioid Anesthetics Addiction: A Review of Current Situation and Mechanism. Brain Sci 2023; 13:1259. [PMID: 37759860 PMCID: PMC10526861 DOI: 10.3390/brainsci13091259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/15/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Drug addiction is one of the major worldwide health problems, which will have serious adverse consequences on human health and significantly burden the social economy and public health. Drug abuse is more common in anesthesiologists than in the general population because of their easier access to controlled substances. Although opioids have been generally considered the most commonly abused drugs among anesthesiologists and nurse anesthetists, the abuse of non-opioid anesthetics has been increasingly severe in recent years. The purpose of this review is to provide an overview of the clinical situation and potential molecular mechanisms of non-opioid anesthetics addiction. This review incorporates the clinical and biomolecular evidence supporting the abuse potential of non-opioid anesthetics and the foreseeable mechanism causing the non-opioid anesthetics addiction phenotypes, promoting a better understanding of its pathogenesis and helping to find effective preventive and curative strategies.
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Affiliation(s)
- Liyun Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; (L.D.); (L.W.); (R.G.); (X.X.); (J.L.)
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lining Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; (L.D.); (L.W.); (R.G.); (X.X.); (J.L.)
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Rui Gao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; (L.D.); (L.W.); (R.G.); (X.X.); (J.L.)
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaolin Xu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; (L.D.); (L.W.); (R.G.); (X.X.); (J.L.)
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chan Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; (L.D.); (L.W.); (R.G.); (X.X.); (J.L.)
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; (L.D.); (L.W.); (R.G.); (X.X.); (J.L.)
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
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24
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Parein G, Bollens B. Nitrous oxide-induced polyneuropathy, pancytopenia and pulmonary embolism: a case report. J Med Case Rep 2023; 17:350. [PMID: 37587485 PMCID: PMC10433604 DOI: 10.1186/s13256-023-04075-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Nitrous oxide is a medical and household gas that has seen its use drift to recreational purpose among the young population in recent years. Significant neurological, hematological and psychiatric side effects, generally related to an induced functional vitamin B12 deficiency, have been described separately in the literature. CASE REPORT A 22-year-old woman of North African origin experienced an exceptional combination of polyneuropathy, bilateral pulmonary embolism and severe pancytopenia related to vitamin B12 deficiency and hyperhomocysteinemia induced by recreational nitrous oxide use. After treatment with vitamin B12 supplementation and intensive rehabilitative management, the patient progressively regained the ability to walk and her biological parameters gradually returned to normal. The pathophysiological mechanisms related to a decrease in vitamin B12 activity are the reduction of products needed for synthesis of deoxyribonucleic acid, carbohydrate or fatty acids, and the increase of hyperhomocysteinemia. Other mechanisms involving a direct action of N2O are also suspected. CONCLUSION This case report brings elements to support our knowledge about pathological pathway, recovery and prognosis of recreational N2O abuse complications. The general and medical population should be aware to the serious consequences of this type of consumption.
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Affiliation(s)
- Guillaume Parein
- Physical and Rehabilitation Medicine Department, CHU Ambroise Paré, Mons, Wallonie, Belgium.
| | - Benjamin Bollens
- Physical and Rehabilitation Medicine Department, CHU Ambroise Paré, Mons, Wallonie, Belgium
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25
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H Moussa A, Mohamed W, Zidouh S. From Medical Analgesic to Recreational Use: A Rare Case of Acute Myelitis Caused by Laughing Gas Abuse. Cureus 2023; 15:e41018. [PMID: 37519576 PMCID: PMC10372704 DOI: 10.7759/cureus.41018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Nitrous oxide, commonly known as laughing gas, which is originally intended to be used in various industries as well as for legitimate medical purposes, has unfortunately come to be used recreationally. However, it is crucial to recognize that the seemingly innocent recreational use of nitrous oxide can have serious repercussions on one's health. When consumed in excessive quantities and for prolonged periods, this substance can lead to serious adverse effects. In this article, we shed light on the abuse potential of the substance by discussing a distressing case of a young nitrous oxide user who developed severe myelitis.
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Affiliation(s)
- Aicha H Moussa
- Emergency Department, Faculty of Medicine and Pharmacy, Military Hospital Mohamed V, Rabat, MAR
| | - Walid Mohamed
- Emergency Department, Faculty of Medicine and Pharmacy, Military Hospital Mohamed V, Rabat, MAR
| | - Saad Zidouh
- Emergency Department, Faculty of Medicine and Pharmacy, Military Hospital Mohamed V, Rabat, MAR
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26
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Tan LYC, Seng AWP. Whippet Abuse Resulting in Subacute Combined Degeneration of the Spinal Cord. Am J Phys Med Rehabil 2023; 102:e56-e57. [PMID: 36228187 DOI: 10.1097/phm.0000000000002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Buttery C, Birns J, Gibson J, Jones GD. Use of the Rehabilitation Treatment Specification System (RTSS) in the management of nitrous oxide (N 2O)-induced spinal cord injury. BMJ Case Rep 2023; 16:16/2/e252529. [PMID: 36750296 PMCID: PMC9906271 DOI: 10.1136/bcr-2022-252529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Nitrous oxide (N2O) is an inhaled anaesthetic gas and a popular intoxicant. Excessive recreational use can cause spinal cord myelopathy. Previous studies have discussed the medical management. However, none have specified the sensorimotor rehabilitation management. This case report documents the investigations, physical rehabilitation and functional outcomes in two cases of N2O-associated myelopathy. Both presented with lower limb strength and sensorimotor integration impairments resulting in ataxic ambulation. Dorsal column signal abnormality was observed on T2-weighted MRI in one case. Myelopathy was diagnosed based on clinical presentation and both were treated with vitamin B12 Rehabilitation was conceived and specified using the Rehabilitation Treatment Specification System (RTSS). Both cases achieved independent indoor gait on hospital discharge, and full function at 9 months in one case. Appropriate and timely medical management and reasoned rehabilitation provided excellent functional outcomes for N2O-related myelopathy. By using the RTSS, reasoned rehabilitation efficacy can be tested in the future.
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Affiliation(s)
- Charlotte Buttery
- Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Physiotherapy Department, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Jonathan Birns
- Department of Ageing & Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jamie Gibson
- Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Workforce Transformation, Health Education England (HEE), Leeds, UK
| | - Gareth David Jones
- Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK .,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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28
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Peng C, Liu X, Wu K, Lang H, He L, Chen N. Nitrous oxide inhalation-induced cerebral venous sinus thrombosis in a 20-year-old man: A case report. Heliyon 2023; 9:e13473. [PMID: 36825186 PMCID: PMC9941988 DOI: 10.1016/j.heliyon.2023.e13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/06/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023] Open
Abstract
Nitrous oxide is increasingly abused in the young population and has been verified to induce neuropathy, myelopathy, encephalopathy, and thrombosis. Nitrous oxide-related thrombosis was identified in the coronary artery, ascending aorta, pulmonary artery, and deep vein in the lower extremities. Cases with nitrous oxide abuse-related thrombosis in cerebral veins or cerebral venous sinus have rarely been reported, and confounding risk factors for thrombosis other than nitrous oxide exist in previous cases. Here, we report a case of probable nitrous oxide abuse-related cerebral venous sinus thrombosis without common confounding risk factors for thrombosis except for nitrous oxide.
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Affiliation(s)
- Cheng Peng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Xi Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, China
| | - Kongyuan Wu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Hui Lang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China,Corresponding author.
| | - Ning Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China,Corresponding author.
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Gao H, Wang R, Zeng Y, Qin L, Cai H, Zhou D, Chen Q. Nitrous oxide-induced neurotoxicity: Clinical characteristics and impacts on overall neurological impairments. Front Neurol 2023; 14:1132542. [PMID: 36908607 PMCID: PMC9995698 DOI: 10.3389/fneur.2023.1132542] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Objective The reports of the recreational use of nitrous oxide (N2O) and its related neuropathy are increasing. However, it is unclear whether specific clinical characteristics are associated with the overall neurological impairments among these individuals. Methods We retrospectively included 20 hospitalized patients with N2O-related neurological complaints between January 2016 and March 2021 at the West China Hospital of Sichuan University. Detailed demographic, clinical features, lab tests, and imaging data were collected. A functional disability rating score (FDRS) was calculated to determine the degree of neurological impairment. The relationships between the aforementioned factors and the FDRS sum score were explored. Results These individuals were aged between 16 and 30 years (mean ± SD: 21.90 ± 4.06). At admission, unsteady gait (95%, nineteen of twenty), weakness (95%, nineteen of twenty), and limb paresthesia (70%, fourteen of twenty) were the most common symptoms; decreased deep tendon reflexes (100%, nineteen of nineteen), reduced muscle strength (95%, nineteen of twenty), and impaired coordination (95%, nineteen of twenty) were frequently found. The FDRS sum scores ranged from 3 to 12. Among all the factors, admission from the emergency room (p = 0.033), decreased hemoglobin (p = 0.004) (without previous VitB12 supplements), decreased red blood cell (RBC) count (p = 0.004) (without previous VitB12 supplements), and increased mean corpuscular volume (p = 0.036) (with previous VitB12 supplements) positively correlated with the FDRS sum score. Conclusion Nitrous oxide (N2O) could lead to severe neurological impairments among users. Abnormal RBC indicators at admission may be associated with a worse clinical presentation and need further attention. Population education about the consequences of N2O consumption and control measures concerning access to N2O should be further emphasized.
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Affiliation(s)
- Hui Gao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruihan Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Zeng
- Neurobiological Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linyuan Qin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hanlin Cai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qin Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Xu J, Zhang Y, Lei C, Sun P, Chen R, Yuan T. Using machine learning to identify factors related to nitrous oxide (laughing gas) relapse among adolescents. Gen Psychiatr 2023; 36:e101003. [PMID: 37144158 PMCID: PMC10151853 DOI: 10.1136/gpsych-2022-101003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/06/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
- Jie Xu
- Beijing Gaoxin Hospital, Beijing, China
- Department of Psychology, Tsinghua University, Beijing, China
- Department of Psychiatry and Psychology, Tianjin Medical University, Tianjin, China
| | - Yi Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang Lei
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Pei Sun
- Department of Psychology, Tsinghua University, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
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Guerlais M, Aquizerate A, Lionnet A, Daveluy A, Duval M, Gérardin M, Istvan M, Laforgue EJ, Victorri-Vigneau C. Nitrous oxide: a unique official French addictovigilance national survey. Front Public Health 2023; 11:1167746. [PMID: 37206871 PMCID: PMC10189051 DOI: 10.3389/fpubh.2023.1167746] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/31/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Nitrous oxide has become over the last few years a public health problem in many countries. France has a dedicated health monitoring system dedicated to the surveillance of the abuse, dependence and consequences associated with the use of psychoactive substances coordinated by the French National Agency for the Safety of Medicines and Health Products.We present the French national survey of nitrous oxide. Materials and methods We analyzed all the cases with nitrous oxide from 2012 to 2021: number of notifications, characteristics of the subjects and consumption, consequences reported and their evolutions over time. In addition, we have made a special focus on the four main complications reported. Results A total of 525 cases were received with an exponential increase since 2019. We observed changes in the characteristics of the notifications with an increase in the proportion of women [42.7% in 2021 vs. 30.8% in 2020 (p = 0.02)]; an increase in the quantities consumed (use of cylinders); a negative evolution of the contexts of use with a search for self-therapeutic effects and use in violent contexts; an increasing trend of the severity of cases [78.1% in 2021 vs. 70.0% in 2020 (p = 0.07)].The main effects were substance use disorders and/or associated criteria (82.5%), neurological disorders (75.4%), psychiatric symptoms (15.4%) and cardiovascular events (8.6%). In terms of evolution, we observed a significant increase in cases with a use disorder and an increase in neurological complications. Moreover, new serious effects, notably cardiovascular events were reported. Discussion The combination of high availability, varied effects from euphoria to relief of discomfort in a stressful global pandemic context and the development of dependence could explain the rapid growth of consumption and the seriousness of the cases.It must now be taken into account that (i) Substance use disorders are associated with nitrous oxide consumption; (ii) clinicians must consider "nitrous oxide" in young subjects presenting different types of manifestations; and (iii) stopping consumption is imperative and is the first treatment. In this context, an addictological assessment must also be carried out.
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Affiliation(s)
- Marylène Guerlais
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
| | - Aurélie Aquizerate
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
| | - Arthur Lionnet
- Nantes Université, CHU Nantes, Service de Neurologie, Nantes, France
- Inserm, U1235, Nantes, France
| | - Amélie Daveluy
- Centre d’Addictovigilance, Département de Pharmacologie Médicale, INSERM, BPH, U1219, CHU de Bordeaux, Bordeaux, France
| | - Mélanie Duval
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
- Nantes Université, CHU Nantes, INSERM, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes, France
| | - Marie Gérardin
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
| | - Marion Istvan
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
- Nantes Université, CHU Nantes, INSERM, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
- Nantes Université, CHU Nantes, INSERM, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
- Nantes Université, CHU Nantes, INSERM, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes, France
- *Correspondence: Caroline Victorri-Vigneau,
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Mechanisms Involved in the Neurotoxicity and Abuse Liability of Nitrous Oxide: A Narrative Review. Int J Mol Sci 2022; 23:ijms232314747. [PMID: 36499072 PMCID: PMC9738214 DOI: 10.3390/ijms232314747] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
The recreational use of nitrous oxide (N2O) has increased over the years. At the same time, more N2O intoxications are presented to hospitals. The incidental use of N2O is relatively harmless, but heavy, frequent and chronic use comes with considerable health risks. Most importantly, N2O can inactivate the co-factor cobalamin, which, in turn, leads to paresthesia's, partial paralysis and generalized demyelinating polyneuropathy. In some patients, these disorders are irreversible. Several metabolic cascades have been identified by which N2O can cause harmful effects. Because these effects mostly occur after prolonged use, it raises the question of whether N2O has addictive properties, explaining its prolonged and frequent use at high dose. Several lines of evidence for N2O's dependence liability can be found in the literature, but the underlying mechanism of action remains controversial. N2O interacts with the opioid system, but N2O also acts as an N-methyl-D-aspartate (NMDA) receptor antagonist, by which it can cause dopamine disinhibition. In this narrative review, we provide a detailed description of animal and human evidence for N2O-induced abuse/dependence and for N2O-induced neurotoxicity.
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Wang J, Liu Z. Research progress on molecular mechanisms of general anesthetic-induced neurotoxicity and cognitive impairment in the developing brain. Front Neurol 2022; 13:1065976. [PMID: 36504660 PMCID: PMC9729288 DOI: 10.3389/fneur.2022.1065976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
General anesthetics-induced neurotoxicity and cognitive impairment in developing brains have become one of the current research hotspots in the medical science community. The underlying mechanisms are complex and involve various related molecular signaling pathways, cell mediators, autophagy, and other pathological processes. However, few drugs can be directly used to treat neurotoxicity and cognitive impairment caused by general anesthetics in clinical practice. This article reviews the molecular mechanism of general anesthesia-induced neurotoxicity and cognitive impairment in the neonatal brain after surgery in the hope of providing critical references for the treatments of clinical diseases.
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Affiliation(s)
- Jiaojiao Wang
- Department of Anesthesiology, Baotou Central Hospital, Baotou, China,Baotou Clinical Medical College, Inner Mongolia Medical University, Baotou, China
| | - Zhihui Liu
- Department of Anesthesiology, Baotou Central Hospital, Baotou, China,*Correspondence: Zhihui Liu
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Dong MX, Wang Q, Xu JF, Hu L, Yu Y, Li T. Case report: Recreational nitrous oxide abuse triggered peripheral neuropathy possibly through the immune-mediated pathogenesis. Front Neurol 2022; 13:1033327. [PMID: 36452172 PMCID: PMC9702802 DOI: 10.3389/fneur.2022.1033327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 10/17/2023] Open
Abstract
Nitrous oxide (N2O), commonly known as laughing gas, is widely used in clinical practice and food industry. However, an increasing number of young people have been abusing N2O for recreational purpose, resulting in many functional disorders and sometimes irreversible nerve damage. We present the case of a 20-year-old N2O abuser who gradually developed peripheral neuropathy after continuously inhaling N2O for 2 months. The neurological symptoms of the patient had kept exacerbation for the next 2 months until she came for medical care sitting in a wheelchair. We suggested the patient halting N2O intake and supplementing methylcobalamine according to the standardized protocol. Her symptoms had partly recovered during the following 2 weeks but remained unchanged in another 2 weeks. Antibodies against ganglioside complexes were detected and anti-GM1 IgM antibodies were positive in both cerebrospinal fluid and serum. Intravenous immunoglobulin was given as an additional treatment and the patient's symptoms had significantly recovered further. The patient discharged walking by herself. Then she has been continuously followed up in outpatient department for the next 4 months and taking steroid hormone as well as methylcobalamine. Her symptoms gradually disappeared and all the electrophysiological parameters significantly improved. With this case we were able to show that N2O-related peripheral neuropathy is not only a metabolic disorder but also an immune-mediated disease. N2O intake can trigger a mimic Guillain-Barré syndrome.
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Affiliation(s)
- Mei-Xue Dong
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
| | - Qing Wang
- Department of Neurology, Wuhan No. 9 Hospital, Wuhan, China
| | - Jun-Feng Xu
- Department of Neurology, Ezhou Central Hospital, Ezhou, China
| | - Ling Hu
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
| | - Ying Yu
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
| | - Tao Li
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
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MacLean SJ, Riddell O, Herold MD, Frank VA. Becoming a nitrous oxide user on social media: Learning to maximise pleasures and minimise harms. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103861. [PMID: 36162207 DOI: 10.1016/j.drugpo.2022.103861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/16/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In his classic work 'Becoming a marihuana user', Howard Becker (1953) showed how drug use learning occurred in social interactions and settings, which in turn shape drug use. Today, social media offers people opportunities to learn about drugs without physical proximity. In this paper, we identify nitrous oxide (N2O) users' key concerns about how to maximise pleasures and minimise harms, as expressed on the social media platform Reddit. In doing so, we consider what learning about N2O online might mean for the provision of drug education in an era of internet technology. METHOD Data are drawn from a Reddit page (subreddit) dedicated to N2O use. We undertook thematic analysis of 655 threads contributed in late-2020. The subreddit is conceptualised as an internet-mediated social world that constitutes drug user knowledges, practices and identities, rather than simply reflecting them. RESULTS Our analysis uncovers practices not previously been reported in academic literature or health information on N2O, such as breathing techniques to maximise the effects and use of filters to reduce exposure to oil residue. While education resources often describe effects as 'mild', users recounted intense pleasures including euphoria, anaesthesia, sensory distortion, hallucination and epiphanies, especially when N2O was used with other drugs. Subreddit members were deeply concerned to minimise the risk of harms. Yet official health advice regarding N2O was not referenced, some misinterpretation of scientific literature was apparent and drug treatment was almost never suggested when people recounted harms. CONCLUSION In contrast to official health resources, the subreddit offers members practical advice on harm reduction. It provides opportunities for users of N2O to position themselves as playful, informed and caring curators of drug use pleasures. We highlight the need for those formulating drug education to engage with the knowledge, practices and identities that emerge within internet-mediated social worlds.
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Affiliation(s)
- Sarah J MacLean
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3083, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, 3083, Australia.
| | - Oscar Riddell
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, 3083, Australia
| | - Maria Dich Herold
- Center for Alcohol and Drug Research, Aarhus University, Bartholins Alle 10, 3. Aarhus C, 8000, Denmark
| | - Vibeke Asmussen Frank
- Center for Alcohol and Drug Research, Aarhus University, Bartholins Alle 10, 3. Aarhus C, 8000, Denmark
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Allan J, Cameron J, Bruno J. A Systematic Review of Recreational Nitrous Oxide Use: Implications for Policy, Service Delivery and Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11567. [PMID: 36141850 PMCID: PMC9517250 DOI: 10.3390/ijerph191811567] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nitrous oxide (N2O) is a dissociative anaesthetic that is sometimes used recreationally. The prevalence of N2O use is difficult to quantify but appears to be increasing. Research on N2O harms and application of harm reduction strategies are limited. The aim of this mixed method systematic review was to collate and synthesise the disparate body of research on recreational nitrous oxide use to inform harm reduction approaches tailored for young people. METHODS To identify publications reporting the recreational use of N2O, a search of public health, psychology and social science databases was conducted. Databases included PubMed, CIHNAL, PsycINFO, Scopus and Web of Science. Grey literature and Google advanced search were also used. Due to limited published literature on the recreational use of N2O, no limit was placed on publication date or study type. A thematic synthesis extracted descriptive and analytical themes from the selected studies. Quality appraisal was conducted using the CASP Tool for Qualitative studies and the Joanna Briggs Institute case report assessment tool. RESULTS The search retrieved 407 reports. Thirty-four were included in the final analysis, including sixteen case reports. The included studies were primarily concerned with raising awareness of the apparently increasing use and subsequently increasing harms of recreational N2O use. There was limited reference to policy or legislative responses in any published studies, no suggestions for harm reduction strategies or application of service level responses. In general, individuals lack awareness of N2O-related harms. CONCLUSION The review found three key areas that deserve further consideration including: (1) policy, (2) service delivery, and (3) harm associated with N2O use. We recommend a top-down (policy) and bottom-up (services delivery/services users) approach to harm reduction for N2O use which also includes further consultation and research with both groups. Future research could explore young people's experience of N2O use including benefits and problems to inform contextually relevant harm reduction strategies.
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Affiliation(s)
- Julaine Allan
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Jacqui Cameron
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia
- Department of Social Work, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Juliana Bruno
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia
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Chen W, Si Z, Bi Y, Yang B. An unusual case of subacute combined degeneration due to nitrous oxide abuse, which relapsed after bariatric surgery: A case report. Medicine (Baltimore) 2022; 101:e30442. [PMID: 36107547 PMCID: PMC9439783 DOI: 10.1097/md.0000000000030442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Several studies have reported subacute combined degeneration (SCD) induced by nitrous oxide (N2O) abuse. However, few studies have reported that N2O-induced SCD recurred because of sleeve gastrectomy after neurological symptoms improved. PATIENT CONCERNS We report the case of an 18-year-old woman who developed paresthesia, weakness in 4 limbs, and an unstable gait after frequent, excessive N2O inhalation. DIAGNOSIS The patient was diagnosed as having SCD. INTERVENTIONS AND OUTCOMES Nineteen days after intravenous mecobalamin and supplementation with other kinds of vitamin B, her weakness and paresthesia resolved. However, 7 months after discharge, the patient experienced recurrence following sleeve gastrectomy. Blood biochemistry revealed low vitamin B12 levels. After a 22-day treatment, similar to the first hospitalization, her residual numbness and unsteady gait improved. LESSONS This case highlights that patients, especially those at high risk of vitamin B12 deficiency, undergoing sleeve gastrectomy require careful nutritional follow-up and routine monitoring of micronutrients such as vitamin B12 and homocysteine. Continuous vigilance is essential for patients with common and rare neurological complications.
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Affiliation(s)
- Wei Chen
- Department of Gastroenterology, Shuguang Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhihua Si
- Department of Neurology, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Yanping Bi
- Department of Emergency Medicine, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, PR China
| | - Bing Yang
- Department of Neurology, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
- Shandong Institute of Neuroimmunology, Jinan, Shandong, China
- Shandong Provincial Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, Shandong, China
- *Correspondence: Bing Yang, Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, No.16766, Jingshi Road, Jinan, Shandong, 250014, China (e-mail: )
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van Amsterdam JG, Nabben T, van den Brink W. Increasing recreational nitrous oxide use: Should we worry? A narrative review. J Psychopharmacol 2022; 36:943-950. [PMID: 35678512 DOI: 10.1177/02698811221082442] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Since 2000, the prevalence of recreational nitrous oxide (N2O) use has increased in the Western world. Although N2O is a relatively safe drug, the overall increase in the use of N2O has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg N2O tanks, allowing high and prolonged dosing, has facilitated this excessive use. This is of concern, because repeated exposure to high doses of N2O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N2O-induced vitamin B12 deficiency. The increasing trend of recreational users with N2O-induced neurological damage at emergency departments confirms the urgency of this development. OBJECTIVE/METHODS This narrative review describes recent trends in N2O use and misuse, the adverse health effects associated with excessive use and the risk factors of excessive use. RESULTS Considering the rising trend in N2O use, particularly among young and other vulnerable people, we propose to take legislative action to limit the availability of N2O, and also advocate for better and timely education of non-users, users and medical professionals about the serious side-effects associated with excessive N2O use. CONCLUSION It is concluded that the increase in excessive N2O use is of serious concern.
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Affiliation(s)
- Jan Gc van Amsterdam
- Department of Psychiatry, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ton Nabben
- Urban Governance and Social Innovation, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Lin SS, Fan IW, Chen CY, Su YJ. A nitrous oxide abuser presenting with cerebral venous thrombosis: A case report. MEDICINE INTERNATIONAL 2022; 2:20. [PMID: 36698503 PMCID: PMC9829206 DOI: 10.3892/mi.2022.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/06/2022] [Indexed: 02/01/2023]
Abstract
The present study describes the case of a 25-year-old male patient who presented to the emergency department with severe headache and vertigo lasting for 3 days. The patient did not have a recent history of trauma. He was vaccinated with a second dose of the AstraZeneca COVID-19 vaccine ~1 month prior, and he suffered from a vitamin B12 deficiency due to nitrous oxide abuse. Upon an examination of his vital signs, he was found to have a body temperature of 36.4˚C, a pulse rate of 64 beats per minute, a respiratory rate of 18 breaths per minute and a blood pressure of 119/68 mmHg. A neurological examination only revealed left homonymous upper quadrantanopia. The serum platelet count of the patient was 361x1,000/µl and he had elevated D-dimer levels (0.98 µg/ml). A provisional clinical diagnosis of acute cerebrovascular accident was made. A computed tomography scan of the head revealed an abnormal hyperattenuation in the straight sinus and bilateral transverse sinuses. A diagnosis of cerebral sinovenous thrombosis (CSVT) was made following a consultation with a neurologist. The patient was treated with enoxaparin at 6,000 IU, levetiracetam at 1,000 mg and mannitol at 100 ml via an intravenous drip. After admission, magnetic resonance venography revealed the absence of flow in the straight sinus and bilateral transverse sinuses. A thrombophilic investigation revealed a plasma homocysteine level of 59.03 µmol/l (upper normal limit, 15.39 µmol/l), a vitamin B12 level of <148 (lower normal limit, 187 pg/ml). CSVT secondary to homocystinemia was diagnosed. The treatment included anticoagulation and vitamin B12 supplementation. The patient was administered vitamin B12 at 500 mcg twice per day, pyridoxine at 50 mg per day, folic acid at 5 mg two times per day and edoxaban at 60 mg per day. After 7 days of treatment, his headache and quadrantanopia were improved, and the patient was discharged.
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Affiliation(s)
- Shum-Shin Lin
- Department of Emergency Medicine, Tao-Yuan General Hospital, Taoyuan City 330, Taiwan, R.O.C
| | - I-Wei Fan
- Department of Emergency Medicine, Tao-Yuan General Hospital, Taoyuan City 330, Taiwan, R.O.C
| | - Chun-Yu Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei 112201, Taiwan, R.O.C
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan, R.O.C.,Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan, R.O.C.,Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei 11260, Taiwan, R.O.C.,Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan, R.O.C.,Correspondence to: Dr Yu-Jang Su, Department of Emergency Medicine, Mackay Memorial Hospital, No. 92, Sec 2, North Chung Shan Road, Taipei 10449, Taiwan, R.O.C.
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Girard A, Farhat S, De Broucker T. Myéloneuropathie due au mésusage du protoxyde d’azote. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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41
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Srichawla BS. Nitrous Oxide/Whippits-Induced Thoracic Spinal Cord Myelopathy and Cognitive Decline With Normal Serum Vitamin B₁₂. Cureus 2022; 14:e24581. [PMID: 35664396 PMCID: PMC9148417 DOI: 10.7759/cureus.24581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abuse of nitrous oxide leads to irreversible neurologic deficits. Nitrous oxide is commonly abused through the inhalation of whipped cream canisters. These whipped cream chargers, also known as "whippits," are widely available in the United States and their sale is unregulated. There is an increasing prevalence of whippet abuse, and many are unaware of the catastrophic effects. The mechanism of injury is mediated through severe depletion of vitamin B₁₂. Here, we report a case of nitrous oxide abuse leading to thoracic cord myelopathy. The patient has been inhaling approximately 80-100 nitrous oxide canisters daily for three months total. A magnetic resonance imaging (MRI) of the spinal cord illustrates the lesion within the thoracic cord. Further diagnostic workup with serum vitamin B₁₂ levels was normal. However, elevated levels of methylmalonic acid (MMA) were seen. Despite supplementation of vitamin B₁₂, the patient’s neurologic deficits persisted, and he was referred to a rehabilitation center. The abuse of whippets is a serious public health threat and warrants greater regulation of their sale. MMA and holotranscobalamin (holoTC) are improved biomarkers for diagnosing vitamin B₁₂ deficiency.
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Joncquel Chevalier-Curt M, Grzych G, Tard C, Lannoy J, Deheul S, Hanafi R, Douillard C, Vamecq J. Nitrous oxide abuse in the emergency practice, and Review of toxicity mechanisms and potential markers. Food Chem Toxicol 2022; 162:112894. [PMID: 35219765 DOI: 10.1016/j.fct.2022.112894] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/21/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Abstract
Nitrous oxide (N2O) toxicity is a concern common to several medical fields. Here, retrospective study of four N2O abuses with neurological signs in the emergency practice provides a preliminary basis for a metabolic Discussion/Review. This latter highlights N2O abuse as pathology of DNA/RNA/protein methylations, for instance consistent with impairments of protein arginine methyltransferases involved in myelinogenesis and myelopathy in patients. Basically, pathogenesis starts with oxidation by N2O of coordinated cobalamine cobalt ions at enzyme sites with impairments of vitamin-B12-dependent pathways. Methionine synthase (methylcobalamine) and methymalonyl-CoA mutase (adenosylcobalamine) are inactivated and cofactor-depleted, respectively. The number of impacted pathways (folate cycle, methylation cycle, S-adenosylmethionine-dependent methyltransferases, transulfuration pathway, Krebs cycle fueling by methylmalonyl-CoA, glutathione synthesis) explains the variety of potential research/laboratory markers, and may provide new clues and future angles to explore N2O toxicity. Overall, homocysteine measurements obviously help diagnosis of N2O abuses. Additional markers may include vitamin-B12, methionine, methylmalonate, dimethylglycine, sarcosine, S-adenosylmethionine to S-adenosylhomocysteine ratio, various S-adenosylamino acids, S-adenosylmethionine-dependent cellular methylations, and additional analytes (propionylcarnitine, propionylglycine, cystathionine and derived metabolites, methylated amino acids [eg arginine], betaine).
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Affiliation(s)
| | - Guillaume Grzych
- CHU Lille, Service d'Hormonologie, Métabolisme, Nutrition, Oncologie, F-59000, Lille, France; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000, Lille, France.
| | - Céline Tard
- U1172, Centre de référence des maladies neuromusculaires Nord/Est/Ile-de-France, Service de neurologie, CHU de Lille, F-59000 Lille, France.
| | - Julien Lannoy
- CHU Lille, Service de Neurologie, CHU Lille, F-59000 Lille, France.
| | - Sylvie Deheul
- CHU Lille, Centre d'Addictovigilance des Hauts de France, Lille, France.
| | - Riyad Hanafi
- CHU Lille, Neuroradiology, CHU Lille, F-59000 Lille, France.
| | - Claire Douillard
- Endocrinology-Diabetology-Metabolism Department, Huriez Hospital, CHU Lille, F-59000 Lille, France.
| | - Joseph Vamecq
- Inserm, Univ. Lille EA 7364 RADEME, CHU Lille, Centre de Biologie Pathologie Génétique, UF Métabolisme Général et Maladies Rares, F-59000, Lille, France.
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The Clinical Presentations of Nitrous Oxide Users in an Emergency Department. TOXICS 2022; 10:toxics10030112. [PMID: 35324737 PMCID: PMC8950993 DOI: 10.3390/toxics10030112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023]
Abstract
Today, the concomitant abuse of nitrous oxide (N2O) and illicit drugs is evident and problematic. However, there are few reports regarding the clinical manifestations of N2O users when they present to the emergency department (ED). The purpose of this study was to describe the clinical presentations, the associated illicit substances used in combination, and the outcomes in N2O users visiting the ED. This was a retrospective observational cohort study. All N2O adult users admitted to the ED at Linkou Chang Gung Memorial Hospital between 2012 and 2020 were included. Demographic variables, clinical symptoms, and examination results were collected from medical records. Univariate comparisons were conducted between pure N2O users and combined illicit drug users. A total of 40 patients were included, 24 of which were pure N2O users. Limb weakness and numbness accounted for the majority of chief complaints. Neurologic symptoms were the most common clinical manifestations (90%). A more severe ED triage level, faster heart rate, greater agitation, and cardiovascular symptoms were significantly noted in combined illicit drug users. In ED, limb numbness/weakness should arouse physicians’ awareness of patients using N2O. Combined use of N2O and illicit drugs can cause great harm to health.
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van Amsterdam J, Brunt TM, Nabben T, van den Brink W. Recreational N 2 O use: just laughing or really bad news? Addiction 2022; 117:268-269. [PMID: 34545980 DOI: 10.1111/add.15652] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tibor M Brunt
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ton Nabben
- Urban Governance and Social Innovation, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Huizink AC. Trends and associated risks in adolescent substance use: e-cigarette use and nitrous oxide use. Curr Opin Psychol 2022; 45:101312. [DOI: 10.1016/j.copsyc.2022.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/14/2022] [Accepted: 02/08/2022] [Indexed: 11/03/2022]
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Berling E, Fargeot G, Aure K, Tran TH, Kubis N, Lozeron P, Zanin A. Nitrous oxide-induced predominantly motor neuropathies: a follow-up study. J Neurol 2021; 269:2720-2726. [PMID: 34741241 DOI: 10.1007/s00415-021-10858-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recreational nitrous oxide (N2O) abuse is increasingly popular among youth. We report a systematic clinical, electrophysiological and biological follow-up of patients with neuropathy caused by N2O. METHODS We retrospectively report seven patients with neuropathy attributed to N2O abuse and their comprehensive follow-up. Demographic, toxicological, clinical, biological and electrophysiological data were collected at first and second examination. Functional data were collected at the last evaluation. RESULTS Seven patients aged 18-30, consuming more than 140 gas-filled balloons (one balloon is filled with approximately 8 g of N2O) per week for over a month, developed a severe, predominantly motor, length-dependent, progressive neuropathy over 3 to 6 weeks. Two-thirds presented associated signs of myelopathy. Distal lower limbs motor deficit and ataxia led to moderate disability. Spinal cord imaging was frequently normal. Nerve conduction studies disclosed an almost exclusively motor axonal neuropathy affecting the lower limbs with active denervation. Homocysteine plasma level was systematically elevated, whereas cobalamin plasma levels were normal in almost all patients. At short-term follow-up after intoxication discontinuation, ataxia and motor deficit only partially resolved despite vitamin B12 supplementation, while active denervation and homocysteinemia decreased. At last follow-up (median 9.2 months, IQR 7.5-10.75), mean ONLS was 2.0 (IQR 2.0-2.0). DISCUSSION Young patients, with induced N2O motor neuropathy remain disabled after 5 to 14.5 months of gas withdrawal, despite vitamin B12 supplementation. A longer follow-up is needed to fully appraise the severity of these toxic neuropathies.
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Affiliation(s)
- Edouard Berling
- Service de Physiologie Clinique-Explorations Fonctionnelles, DMU DREAM, APHP, Hôpital Lariboisière, 75010, Paris, France
| | - Guillaume Fargeot
- Service de Neurologie, APHP, Hôpital du Kremlin-Bicêtre, 94275, Le Kremlin Bicêtre, France
| | - Karine Aure
- Service de Neurophysiologie, Hôpital Foch, 92150, Suresnes, France
| | - Tuan Huy Tran
- Service de Neurologie, APHP, Hôpital Lariboisière, 75010, Paris, France
| | - Nathalie Kubis
- Service de Physiologie Clinique-Explorations Fonctionnelles, DMU DREAM, APHP, Hôpital Lariboisière, 75010, Paris, France.,Laboratory for Vascular Translational Science, INSERM U1148, Université de Paris, 75018, Paris, France
| | - Pierre Lozeron
- Service de Physiologie Clinique-Explorations Fonctionnelles, DMU DREAM, APHP, Hôpital Lariboisière, 75010, Paris, France. .,Laboratory for Vascular Translational Science, INSERM U1148, Université de Paris, 75018, Paris, France.
| | - Adrien Zanin
- Service de Physiologie Clinique-Explorations Fonctionnelles, DMU DREAM, APHP, Hôpital Lariboisière, 75010, Paris, France.,Laboratory for Vascular Translational Science, INSERM U1148, Université de Paris, 75018, Paris, France
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Redmond J, Cruse B, Kiers L. Nitrous Oxide-Induced Neurological Disorders - an increasing public health concern. Intern Med J 2021; 52:740-744. [PMID: 34569693 DOI: 10.1111/imj.15544] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/06/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neurologic presentations resulting from nitrous oxide (N2 O) abuse are increasing in Australia and worldwide. Despite known neuropsychiatric sequelae nitrous oxide canisters remain readily available and its use unregulated. AIMS To examine the demographics, clinical and electrophysiological findings of patients presenting with neurological complications of N2 O abuse, and thus inform clinicians and public health decision makers of the significant public health concerns of this increasing practice. METHODS Consecutive patients presenting to a tertiary referral, metropolitan hospital were included in this series. Patients were identified by a search of discharge summaries of patients admitted with acute or subacute neuropathy or myelopathy and a history of N2 O abuse, and from the electrophysiology database. RESULTS Thirteen patients were identified, most presenting with subacute paraesthesia, sensory ataxia and lower limb weakness. Eleven had low serum vitamin B12 . Spinal magnetic resonance imaging was consistent with subacute combined degeneration (SACD) in 8. Nerve conduction studies revealed a motor or sensorimotor axonal neuropathy (3 with motor predominance). There was a bimodal demographic distribution consisting of socially isolated, international university students and local residents with a history of mental illness and polydrug abuse. CONCLUSIONS Recreational N2 O use is an emerging health problem in Australia. International university students and patients with pre-existing mental illness or polydrug use appear to be at increased risk. A severe motor neuropathy may emerge following Vitamin B12 replacement. Public health measures are required to limit the availability of N2 O and to educate adolescents and young adults about the potential for significant harm. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jessica Redmond
- Department of Neurology, Royal Melbourne Hospital, Parkville, Vic, Australia
| | - Belinda Cruse
- Department of Neurology, Royal Melbourne Hospital, Parkville, Vic, Australia.,Department of Medicine (RMH), Faculty of Medicine, Health and Dentistry, The University of Melbourne
| | - Lynette Kiers
- Department of Neurology, Royal Melbourne Hospital, Parkville, Vic, Australia.,Department of Medicine (RMH), Faculty of Medicine, Health and Dentistry, The University of Melbourne
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Cruz SL, Bowen SE. The last two decades on preclinical and clinical research on inhalant effects. Neurotoxicol Teratol 2021; 87:106999. [PMID: 34087382 DOI: 10.1016/j.ntt.2021.106999] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/24/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022]
Abstract
This paper reviews the scientific evidence generated in the last two decades on the effects and mechanisms of action of most commonly misused inhalants. In the first section, we define what inhalants are, how they are used, and their prevalence worldwide. The second section presents specific characteristics that define the main groups of inhalants: (a) organic solvents; (b) aerosols, gases, and volatile anesthetics; and (c) alkyl nitrites. We include a table with the molecular formula, structure, synonyms, uses, physicochemical properties and exposure limits of representative compounds within each group. The third and fourth sections review the direct acute and chronic effects of common inhalants on health and behavior with a summary of mechanisms of action, respectively. In the fifth section, we address inhalant intoxication signs and available treatment. The sixth section examines the health effects, intoxication, and treatment of nitrites. The seventh section reviews current intervention strategies. Finally, we propose a research agenda to promote the study of (a) solvents other than toluene; (b) inhalant mixtures; (c) effects in combination with other drugs of abuse; (d) age and (e) sex differences in inhalant effects; (f) the long-lasting behavioral effects of animals exposed in utero to inhalants; (g) abstinence signs and neurochemical changes after interrupting inhalant exposure; (h) brain networks involved in inhalant effects; and finally (i) strategies to promote recovery of inhalant users.
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Affiliation(s)
- Silvia L Cruz
- Department of Pharmacobiology, Center of Research and Advanced Studies (Cinvestav), Calzada de los Tenorios No. 235, Col. Granjas Coapa, México City 14330, México.
| | - Scott E Bowen
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7906.1, Detroit, MI 48202, USA.
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