Recreational nitrous oxide abuse related subacute combined degeneration of the spinal cord in adolescents - A case series and literature review.

Shih-Yun Lan, Cheng-Yen Kuo, Cheng-Che Chou, Shu-Sing Kong, Po-Cheng Hung, Hsin-Yu Tsai, Yi-Ching Chen, Jainn-Jim Lin, I-Jun Chou, Kuang-Lin Lin

Journal: Brain & development 2019;41(5):428-435

PMID: 30611595

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Nitrous oxide (NO) is a commonly used inhaled anesthetic in outpatient dental procedures. However, the increasing recreational use of NO may result in vitamin B deficiency-related neurologic and psychiatric symptoms. The aim of this study was to demonstrate the clinical features of chronic NO abuse in pediatric patients.

METHODS

Patients under 20 years of age who were diagnosed with NO-induced subacute combined degeneration of the spinal cord from 2012 to 2018 were enrolled in this study. Clinical presentations, laboratory, imaging, ancillary studies, treatments and outcomes were analyzed.

RESULTS

Nine patients were included, all of whom presented with symptoms of myeloneuropathy including limb numbness, limb weakness or unsteady gait. Six patients had low or low-normal vitamin B (cyanocobalamin) levels. Eight patients had evidence of subacute combined degeneration of the spinal cord via neuroimaging studies. All of the patients received vitamin B supplementation as treatment. All had full recovery of muscle power within 2 months. Five patients had persistent sensory deficits.

CONCLUSION

Chronic NO abuse can cause permanent neurological damage if not treated promptly. Clinical staff should be aware of the various presentations of neurotoxicity related to NO abuse.

Address: Department of Pediatric Neurology, Saint Paul's Hospital, Taoyuan, Taiwan.; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: [email protected].; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: [email protected].; Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taiwan. Electronic address: [email protected].; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung, Taiwan. Electronic address: [email protected].; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: [email protected].; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: [email protected].; Study Group for Prevention and Protection Against Child Abuse and Neglect (PCHAN), Taiwan.

DOI: 10.1016/j.braindev.2018.12.003

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MeSH Terms: Adolescent, Adult, Female, Humans, Male, Nitrous Oxide, Outcome Assessment, Health Care, Subacute Combined Degeneration, Substance-Related Disorders, Vitamin B 12, Vitamin B 12 Deficiency, Vitamin B Complex, Young Adult