Increase of nitrous oxide-induced neurological disorders – a German multicenter experience

Abstract

Nitrous oxide (N₂O), commonly known as laughing gas, is widely recognized for its anesthetic and analgesic effects, and is frequently used in medical contexts. However, its misuse can lead to significant neurological complications, which are often under-recognized in clinical practice. Recent data on such cases in Germany are rare. We here report the spectrum of neurological complications associated with the recreational use of N₂O, as encountered in German neurology centers. We retrospectively analyzed of 23 cases presenting with neurological symptoms following N₂O abuse between July 2020 and August 2024 across five neurology departments in Germany. Data were collected on patient demographics, clinical manifestations, diagnostic findings, and treatment approaches. Over the last four years the number of cases increased. Clinical presentations primarily included neuropathy, found in all patients, along with myelopathy. The most common symptoms were sensory loss, ataxia, and motor deficits. Our data suggest that N₂O abuse is on the rise in Germany. Further initiatives are warranted to raise awareness among users, healthcare and professionals.