1
|
Farmer J, Romain K, Ibrahim M, Kumar M, York Moore W. The neuropsychiatric effects of nitrous oxide and low vitamin B 12. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
This narrative review article aims to update knowledge on the neuropsychiatric complications of nitrous oxide use and low vitamin B12. We consider common forms and uses of nitrous oxide (N2O) and review its mechanism of action, and then explore the potential impacts of use. In particular, neuropsychiatric effects mediated by low vitamin B12 are considered and the correct interpretation of laboratory results explored. This is of particular importance as where vitamin B12 is inactivated by chronic nitrous oxide use, blood test levels of vitamin B12 may not reflect the quantity of functional B12 in patients.
Collapse
|
2
|
Biag HMB, Potter LA, Wilkins V, Afzal S, Rosvall A, Salcedo-Arellano MJ, Rajaratnam A, Manzano-Nunez R, Schneider A, Tassone F, Rivera SM, Hagerman RJ. Metformin treatment in young children with fragile X syndrome. Mol Genet Genomic Med 2019; 7:e956. [PMID: 31520524 PMCID: PMC6825840 DOI: 10.1002/mgg3.956] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/07/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Metformin is a drug commonly used in individuals with type 2 diabetes, obesity, and impaired glucose tolerance. It has a strong safety profile in both children and adults. Studies utilizing the Drosophila model and knock out mouse model of fragile X syndrome (FXS) have found metformin to rescue memory, social novelty deficits, and neuroanatomical abnormalities. These studies provided preliminary evidence that metformin could be used as a targeted treatment for the cognitive and behavioral problems associated with FXS. Previously, a case series of children and adults with FXS treated with metformin demonstrated improvements in irritability, social responsiveness, language, and hyperactivity. METHODS Here, we present nine children with FXS between 2 and 7 years of age who were treated clinically with metformin and monitored for behavioral and metabolic changes. RESULTS Parent reports and developmental testing before and after metformin are presented. There were improvements in language development and behavior (such as lethargy and stereotypy) in most of the patients. CONCLUSION These results support the need for a controlled trial of metformin in children with FXS under 7 years old whose brains are in a critical developmental window and thus may experience a greater degree of clinical benefit from metformin.
Collapse
Affiliation(s)
- Hazel Maridith B Biag
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
| | - Laura A Potter
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
| | - Victoria Wilkins
- Department of Pediatric Inpatient Medicine, University of Utah and Primary Children's Hospital, Salt Lake City, Utah
| | - Sumra Afzal
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
| | - Alexis Rosvall
- University of California Davis School of Medicine, Sacramento, California
| | - Maria Jimena Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
| | - Akash Rajaratnam
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California.,Department of Biochemistry and Molecular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Susan M Rivera
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California.,Department of Psychology, University of California Davis, Davis, California.,Neurocognitive Development Lab, Center for Mind and Brain, Davis, California
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
| |
Collapse
|
3
|
Kremmyda O, Forbrig R, Heinrich J, Winkler T, Straube A. Subcortical lesions due to cobalamin deficiency: an unusual MRI lesion pattern. Nutr Neurosci 2019; 24:564-568. [PMID: 31454297 DOI: 10.1080/1028415x.2019.1657659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present a 44-year-old male patient with new onset of right focal epilepsy and bilateral hand hypesthesia. Cerebral MRI showed bilateral T2w/DWI hyperintense subcortical lesions in the cingulate gyrus, insula, and amygdala, whereas spinal MRI revealed a cervical posterior column lesion, corresponding to subacute combined degeneration. Laboratory workup revealed a cobalamin deficiency due to type A gastritis, and no evidence of antibodies associated with limbic encephalitis. After sufficient cobalamin substitution, the cerebral and spinal lesions gradually regressed. Our case represents a unique cerebral subcortical MRI lesion pattern in a patient with epilepsy and cobalamin deficiency. Thus, the latter represents an important differential diagnosis for autoimmune encephalitis.
Collapse
Affiliation(s)
- Olympia Kremmyda
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, Ludwig Maximilians University, Munich, Germany
| | - Johanna Heinrich
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Tobias Winkler
- Department of Neurology, kbo-Inn-Salzach-Hospital, Wasserburg am Inn, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| |
Collapse
|
4
|
Meena MK, Sharma S, Bhasin H, Jain P, Kapoor S, Jain A, Aneja S. Vitamin B 12 Deficiency in Children With Infantile Spasms: A Case-Control Study. J Child Neurol 2018; 33:767-771. [PMID: 30032694 DOI: 10.1177/0883073818787062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There have been few case reports showing association of vitamin B12 deficiency with infantile spasms. We planned this study to see if there was an association of serum vitamin B12 deficiency in children with development of infantile spasms. Cases included children with infantile spasms of ages 6 months to 3 years. The controls were children in the same age group who had global developmental delay but no history of epileptic spasms. Mean serum vitamin B12, serum homocysteine, and urinary methylmalonic acid levels were measured in both groups and compared. Children with infantile spasms had lower mean serum vitamin B12 levels (354.1 pg/mL; standard deviation 234.1 pg/mL) as compared to children with global developmental delay without spasms (466.7 pg/mL; standard deviation 285.5 pg/mL) ( P value < .05). Mean serum homocysteine level (13.9 vs 7.8 μmol/L, P = .02) and mean urinary methylmalonic acid level (68.1 mmol/mol of creatinine vs 26.1 mmol/mol of creatinine, P = .03) were elevated in children with infantile spasms than in controls. Fourteen children (35.0%) with infantile spasms were vitamin B12 deficient compared with 3 (7.50%) controls ( P = .005). Thus, vitamin B12 deficiency may have an association with infantile spasms. More studies are needed before recommending routine measurement of serum B12 levels in children with infantile spasms.
Collapse
Affiliation(s)
- Mahender K Meena
- 1 Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Suvasini Sharma
- 2 Division of Pediatric Neurology, Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Himani Bhasin
- 1 Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Puneet Jain
- 2 Division of Pediatric Neurology, Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Seema Kapoor
- 3 Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Anju Jain
- 4 Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Satinder Aneja
- 2 Division of Pediatric Neurology, Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| |
Collapse
|
5
|
Serin HM, Kara AO, Oğuz B. West syndrome due to vitamin B12 deficiency. Turk Arch Pediatr 2015; 50:251-3. [PMID: 26884697 DOI: 10.5152/turkpediatriars.2015.1492] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 02/20/2014] [Indexed: 11/22/2022]
Abstract
Vitamin B12 is one of the essential vitamins affecting various systems of the body. Vitamin B12 deficiency in infants often produces haematological and neurological deficits including macrocyticanaemia, neurodevelopmental delay or regression, irritability, weakness, hypotonia, ataxia, apathy, tremor andseizures. In this article, we report the case of a six-month-old male patient diagnosed with West syndrome associated with vitamin B12 deficiency. Although the patient had no evidence of macrocytic anemia in complete blood count, we measured the level of vitamin B12 because the patient had hypotonicity and found it to be low. No other problem was found in the other investigations directed to the etiology of West syndrome. He was being exclusively breast-fed and vitamin B12 deficiency was related with nutritional inadequacy of his mother. Vitamin B12 deficiency should be considered in the differential diagnosis of patients presenting with different neurological findings. In addition, vitamin B12 deficiency should be considered as a rare cause in West syndrome which has a heterogeneous etiology.
Collapse
Affiliation(s)
- Hepsen Mine Serin
- Department of Pediatrics, Division of Pediatric Neurology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | | | - Baran Oğuz
- Department of Pediatrics, Fırat University Faculty of Medicine, Elazığ, Turkey
| |
Collapse
|
6
|
Lubana SS, Alfishawy M, Singh N, Atkinson S. Vitamin B12 Deficiency and Elevated Folate Levels: An Unusual Cause of Generalized Tonic-Clonic Seizure. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:386-9. [PMID: 26101427 PMCID: PMC4484606 DOI: 10.12659/ajcr.893847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 49 Final Diagnosis: Generalized tonic-clonic seizures in the setting of vitamin B12 deficiency and elevated folate levels Symptoms: Seizures Medication: — Clinical Procedure: None Specialty: Neurology
Collapse
Affiliation(s)
- Sandeep Singh Lubana
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Mostafa Alfishawy
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Navdeep Singh
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| | - Sharon Atkinson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA
| |
Collapse
|
7
|
Vitamin-responsive epileptic encephalopathies in children. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:510529. [PMID: 23984056 PMCID: PMC3745849 DOI: 10.1155/2013/510529] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 06/18/2013] [Indexed: 01/12/2023]
Abstract
Untreated epileptic encephalopathies in children may potentially have disastrous outcomes. Treatment with antiepileptic drugs (AEDs) often may not control the seizures, and even if they do, this measure is only symptomatic and not specific. It is especially valuable to identify potential underlying conditions that have specific treatments. Only a few conditions have definitive treatments that can potentially modify the natural course of disease. In this paper, we discuss the few such conditions that are responsive to vitamin or vitamin derivatives.
Collapse
|
8
|
Naha K, Dasari S, Vivek G, Prabhu M. Vitamin B₁₂ deficiency: an unusual cause for recurrent generalised seizures with pancytopaenia. BMJ Case Rep 2012; 2012:bcr-2012-006632. [PMID: 22948998 DOI: 10.1136/bcr-2012-006632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 70-year-old man with pancytopaenia and new-onset recurrent generalised seizures. Detailed evaluation yielded a diagnosis of vitamin B(12) deficiency. He was treated with parenteral vitamin B(12) supplementation and antiepileptic drugs. Seizures are an unusual manifestation of vitamin B(12) deficiency and possible mechanisms of epileptogenesis are discussed.
Collapse
Affiliation(s)
- Kushal Naha
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | | | | | | |
Collapse
|
9
|
Matsumoto A, Shiga Y, Shimizu H, Kimura I, Hisanaga K. [Encephalomyelopathy due to vitamin B12 deficiency with seizures as a predominant symptom]. Rinsho Shinkeigaku 2009; 49:179-85. [PMID: 19462816 DOI: 10.5692/clinicalneurol.49.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a 39-year-old man who developed seizures as a predominant symptom of vitamin B12 deficiency. About a month before admission to our hospital, he experienced flickering vision, and had generalized convulsive seizures about ten times a day. On admission, he presented with visual disturbance and paralysis of the left leg. Brain MRI revealed a tumor-like lesion in the medial side of the right frontal lobe. Follow-up MRI about 2 weeks after admission demonstrated multiple lesions in the periaqueduct, the medial side of the bilateral thalami, the bilateral frontal lobes, and the bilateral occipital lobes. After administration of antiepileptic drugs, his condition was well-controlled. Paralysis of his left leg was gradually improved, and abnormal findings on brain MRI disappeared except that in the right frontal lobe cortex, which was considered to be cortical laminar necrosis. 123I-IMP-SPECT showed hyperperfusion in the bilateral occipital lobes. About 3 months after the first admission, he was readmitted because of ataxic gait and numbness in the extremities. Laboratory tests revealed macrocytic anemia and vitamin B12 deficiency. Spinal MRI revealed typical findings of subacute combined degeneration. Brain MRI showed multiple new lesions in the bilateral dorsal sides of the medulla, cerebellar hemispheres, interthalamic adhesion, and left frontal cortex. After the initiation of vitamin B12 supplementary therapy, the symptoms were improved, and the abnormal MRI findings disappeared. Serum anti-gastric-parietal-cell antibody and anti-intrinsic-factor antibody were positive. 123I-IMP-SPECT demonstrated hypoperfusion in the bilateral occipital lobes, possibly reflecting visual disturbance. To the best of our knowledge, this is the first report indicating that vitamin B12 deficiency may insult various brain regions as well as the spinal cord with reversibility. Vitamin B12 deficiency should be also considered in the differential diagnosis of the causes of epilepsy.
Collapse
|
10
|
Erol I, Alehan F, Gümüs A. West syndrome in an infant with vitamin B12 deficiency in the absence of macrocytic anaemia. Dev Med Child Neurol 2007; 49:774-6. [PMID: 17880648 DOI: 10.1111/j.1469-8749.2007.00774.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Vitamin B(12) deficiency in infants often produces haematological and neurological deficits, including macrocytic anaemia, neurodevelopmental delay or regression, irritability, weakness, hypotonia, ataxia, apathy, tremor, and seizures. The diagnosis of vitamin B(12) deficiency can be difficult when the typical macrocytic anaemia is absent. We report the case of a 10-month-old female diagnosed with West syndrome associated with vitamin B(12) deficiency but without macrocytic anaemia caused by nutritional inadequacy in the mother. The patient's motor skills and cognitive development were normal until she was 9 months old, when she began to exhibit a series of sudden flexions of the head, trunk, arms, and legs. She was exclusively breast-fed and had received no vitamin supplementation. Results of electroencephalography (EEG) indicated modified hypsarrhythmia and the patient was diagnosed as having West syndrome. Synthetic adrenocorticotropic hormone was administered and although her spasms had resolved, the patient remained apathic and could not sit without assistance. EEG results indicated generalized slow activity. After she was diagnosed as having vitamin B(12) deficiency, parenteral treatment with vitamin B(12) was initiated. Her symptoms resolved and EEG was completely normal. When she was 20 months old she exhibited an age-appropriate developmental and neurological profile. To our knowledge, this is the first report of West syndrome as a presenting symptom of vitamin B(12) deficiency.
Collapse
Affiliation(s)
- Ilknur Erol
- Division of Child Neurology, Department of Paediatrics, Baskent University Faculty of Medicine, Ankara, Turkey.
| | | | | |
Collapse
|
11
|
Solomon LR. Disorders of cobalamin (Vitamin B12) metabolism: Emerging concepts in pathophysiology, diagnosis and treatment. Blood Rev 2007; 21:113-30. [DOI: 10.1016/j.blre.2006.05.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|