Nitrous oxide-induced subacute combined degeneration of the cord: diagnosis and treatment
Álvaro París, Luke Lake, Albert Joseph, Anna Workman, Joseph Walton, T. Hayton, N. Evangelou, James B. Lilleker, R. Ayling, D. Nicholl, Alastair J. Noyce
Practical Neurology February 22, 2023 DOI: 10.1136/pn-2022-003631 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Practical guide or manual Peer reviewed |
|---|---|
| Key points | The authors argue that nitrous oxide-induced subacute combined degeneration of the cord (N2O-SACD) is a rising cause of serious, potentially permanent disability in young people that can be treated effectively if recognized early. Because no agreed guidelines exist, they provide practical advice, based on their East London experience, on recognizing, investigating, and treating the condition, and contend that all neurologists should be aware of it. |
Abstract
Recreational use of nitrous oxide (N2O) has increased rapidly in recent years and is now the second most commonly used recreational drug among young people in the UK. There has been a corresponding rise in cases of nitrous oxide-induced subacute combined degeneration of the cord (N2O-SACD), a pattern of myeloneuropathy usually associated with severe vitamin B12 deficiency. This can cause serious and permanent disability in young people but, if recognised early, may be effectively treated. All neurologists should be aware of N2O-SACD and its treatment; however, there are currently no agreed guidelines. Based on our experience in East London, an area of high N2O use, we provide practical advice on its recognition, investigation and treatment.
Citations in the library
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- [Nitrous oxide as a party drug]. Die Anaesthesiologie July 1, 2024
- A Diagnostic Challenge in Polysubstance Use: Nitrous Oxide–induced Neurological Toxicity Masked by Alcohol Withdrawal—A Case Report Canadian Journal of Addiction August 7, 2026
- Nitrous oxide–related neurotoxicity: Clinical features, key investigations, and a proposed diagnostic approach from a single-center cohort eNeurologicalSci May 1, 2026
- The Toxic Legacy of Recreational Nitrous Oxide Use: A Systematic Review and Meta-Analysis of Multisystem Complications From Functional Vitamin B12 Deficiency Cureus May 1, 2026
- Addressing the Global Challenge of Nitrous Oxide Misuse Through a Multidisciplinary Approach: Example of the PROTOSIDE Network Toxics May 31, 2025
and 5 more in the library
Cites 4
- Review article: Clinical manifestations and outcomes of chronic nitrous oxide misuse: A systematic review Emergency Medicine Australasia June 13, 2022
- Problematic Use of Nitrous Oxide by Young Moroccan-Dutch Adults. International Journal of Environmental Research and Public Health May 23, 2021
- Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users Journal of Psychopharmacology February 1, 2020
- No laughing matter: subacute degeneration of the spinal cord due to nitrous oxide inhalation Journal of Neurology March 3, 2018