Laughing gas patients growing amid rise in use of larger nitrous oxide cylinders

Published online 2021 Aug 21.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8379581/

 

Neurological consequences of recreational nitrous oxide abuse during SARS-CoV-2 pandemic

Abstract

Introduction

Recreational use of nitrous oxide (N2O) is a growing practice in France and all around the world and is often associated with neurological complications. We report detailed clinical and paraclinical presentations of 12 patients with combined degeneration of the spinal cord and peripheral neuropathies in relation to N2O consumption, possibly favored by lockdowns due to SARS-CoV-2 pandemic.

 

Results

With variable levels of consumption, the 12 patients presented spinal cord and/or peripheral nerve damage, with mostly motor and ataxic symptoms, motor axonal nerve damage, and medullary T2-weighted hyperintensities on MRI. There was a clear improvement in symptoms after vitamin B12 substitution, although some sequelae remained, particularly sensory.

 

Discussion

We report detailed clinical, electrophysiological, radiological, and biological consequences of N2O abuse in 12 patients. Our data support the clinical and paraclinical observations reported in the literature. The mechanisms of neurological N2O toxicity are still debated. There is currently no precise recommendation on the therapeutic management. The clinical evolution after vitamin B12 substitution seems sufficient but could depend on early management. Effective messages targeting at risk population, but also the health professionals involved, seem crucial as does a better legal framework for this growing practice.

 

Exposure to nitrous oxide (N2O) is associated with multiple complications, especially neurological ones [1]. The first reported cases mainly concerned situations of occupational or post-operative exposure.

 

Recreational use of N2O, mainly through freely bought food cartridges, inhaled either directly or via a balloon, has sharply increased since a few years. It was believed to be the second most common psychoactive substance consumed by French students between 2015 and 2017 [2]. Since then, there has been a growing frequency of serious complications linked to this consumption, particularly in France, as indicated in reports by the French addictovigilance network and the French Health Security Agency in June 2020. Surveillance data on psychoactive substances consumed in France identify an important and sustained N2O consumption during the SARS-CoV-2 epidemic, especially during the first lockdown, in relation to a difficulty of access to other substances and a need to consume due to inactivity [3]. Worldwide, N2O abuse is already responsible for several cases of death [1].

 

In our article, we describe clinically, biologically, radiologically and neurophysiologically 12 cases of spinal cord injury and/or peripheral neuropathies secondary to N2O recreational consumption that occurred between August 2020 and April 2021 and were treated in our Neurology Department at the Avicenne University Hospital. All the data were obtained from the records of patients.

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