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Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations
Background: Nitrous oxide (N(2)O), commonly known as laughing gas, is inhaled recreationally because it produces the feelings of euphoria and freedom from pain. The risk of neurological dysfunction secondary to N(2)O abuse and its clinical diagnosis are, however, not yet sufficiently recognized, esp...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110825/ https://www.ncbi.nlm.nih.gov/pubmed/33986715 http://dx.doi.org/10.3389/fneur.2021.627183 |
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author | Zhang, Juanjuan Xie, Dandan Zou, Yanfeng Yu, Xuen Ji, Yang Wang, Chengyou Lv, Xinyi Zhou, Nong Jiang, Xiao Wang, Kai Tian, Yanghua |
author_facet | Zhang, Juanjuan Xie, Dandan Zou, Yanfeng Yu, Xuen Ji, Yang Wang, Chengyou Lv, Xinyi Zhou, Nong Jiang, Xiao Wang, Kai Tian, Yanghua |
author_sort | Zhang, Juanjuan |
collection | PubMed |
description | Background: Nitrous oxide (N(2)O), commonly known as laughing gas, is inhaled recreationally because it produces the feelings of euphoria and freedom from pain. The risk of neurological dysfunction secondary to N(2)O abuse and its clinical diagnosis are, however, not yet sufficiently recognized, especially in China. Here, we have summarized the key clinical characteristics of N(2)O-induced neurological disorders. Materials and Methods: We recruited 20 patients with N(2)O-induced neurological disorders and analyzed their clinical features, laboratory data, magnetic resonance imaging and electromyography. We also carried out a literature review and compared 99 previously reported patients with our case series to confirm our results. Subgroup analysis was performed to explore the difference in demographical and clinical characteristics of N(2)O abuse between Asian and non-Asian patients. Results: The most common initial symptoms of N(2)O-induced neurological disorders were weakness and/or paresthesia. Most patients presented with myelopathy and/or peripheral neuropathy. The most commonly involved segment of the spinal cord was the cervical spinal cord, extending over 4–6 vertebral levels, but more than half of the patients with myelopathy had no sensory change at the corresponding spinal level. Homocysteine was found to be the most sensitive and practical indicator for diagnosis. Subgroup analysis showed that the Asian patients (median: 22.0 years old, Q1–Q3:19.0–26.0 years old) with N(2)O abuse were younger than non-Asian patients [26.0 (22.3–31.0) years old, P = 2.8 × 10(−4)]. The incidence of myelopathy combined with peripheral neuropathy was significantly higher in Asian patients than in non-Asian patients, who had myelopathy or peripheral neuropathy (P = 2 × 10(−5)). Conclusions: Key clinical characteristics of N(2)O abuse are longitudinally extensive cervical myelopathy and peripheral neuropathy. Recognition of these traits in young people in the age group of 20–30 years will provide important guidance for accurate diagnosis of neurological disease associated with N(2)O abuse. The clinical manifestations differ in Asian patients and non-Asian patients. |
format | Online Article Text |
id | pubmed-8110825 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-81108252021-05-12 Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations Zhang, Juanjuan Xie, Dandan Zou, Yanfeng Yu, Xuen Ji, Yang Wang, Chengyou Lv, Xinyi Zhou, Nong Jiang, Xiao Wang, Kai Tian, Yanghua Front Neurol Neurology Background: Nitrous oxide (N(2)O), commonly known as laughing gas, is inhaled recreationally because it produces the feelings of euphoria and freedom from pain. The risk of neurological dysfunction secondary to N(2)O abuse and its clinical diagnosis are, however, not yet sufficiently recognized, especially in China. Here, we have summarized the key clinical characteristics of N(2)O-induced neurological disorders. Materials and Methods: We recruited 20 patients with N(2)O-induced neurological disorders and analyzed their clinical features, laboratory data, magnetic resonance imaging and electromyography. We also carried out a literature review and compared 99 previously reported patients with our case series to confirm our results. Subgroup analysis was performed to explore the difference in demographical and clinical characteristics of N(2)O abuse between Asian and non-Asian patients. Results: The most common initial symptoms of N(2)O-induced neurological disorders were weakness and/or paresthesia. Most patients presented with myelopathy and/or peripheral neuropathy. The most commonly involved segment of the spinal cord was the cervical spinal cord, extending over 4–6 vertebral levels, but more than half of the patients with myelopathy had no sensory change at the corresponding spinal level. Homocysteine was found to be the most sensitive and practical indicator for diagnosis. Subgroup analysis showed that the Asian patients (median: 22.0 years old, Q1–Q3:19.0–26.0 years old) with N(2)O abuse were younger than non-Asian patients [26.0 (22.3–31.0) years old, P = 2.8 × 10(−4)]. The incidence of myelopathy combined with peripheral neuropathy was significantly higher in Asian patients than in non-Asian patients, who had myelopathy or peripheral neuropathy (P = 2 × 10(−5)). Conclusions: Key clinical characteristics of N(2)O abuse are longitudinally extensive cervical myelopathy and peripheral neuropathy. Recognition of these traits in young people in the age group of 20–30 years will provide important guidance for accurate diagnosis of neurological disease associated with N(2)O abuse. The clinical manifestations differ in Asian patients and non-Asian patients. Frontiers Media S.A. 2021-04-27 /pmc/articles/PMC8110825/ /pubmed/33986715 http://dx.doi.org/10.3389/fneur.2021.627183 Text en Copyright © 2021 Zhang, Xie, Zou, Yu, Ji, Wang, Lv, Zhou, Jiang, Wang and Tian. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Zhang, Juanjuan Xie, Dandan Zou, Yanfeng Yu, Xuen Ji, Yang Wang, Chengyou Lv, Xinyi Zhou, Nong Jiang, Xiao Wang, Kai Tian, Yanghua Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations |
title | Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations |
title_full | Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations |
title_fullStr | Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations |
title_full_unstemmed | Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations |
title_short | Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations |
title_sort | key characteristics of nitrous oxide-induced neurological disorders and differences between populations |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110825/ https://www.ncbi.nlm.nih.gov/pubmed/33986715 http://dx.doi.org/10.3389/fneur.2021.627183 |
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