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The sharp rise of neurological disorders associated with recreational nitrous oxide use in China: a single-center experience and a brief review of Chinese literature

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Abstract

Introduction

In recent years, there has been a sharp increase in the number of patients with neurological disorders associated with recreational use of nitrous oxide (N2O) in China. Here, we summarize the clinical characteristics of patients with neurological disorders associated with N2O abuse diagnosed in our Hospital. Further, we conducted a literature search on recent cases reported in mainland China to improve the awareness of the outbreak of neurological disorders associated with N2O abuse.

Methods

We retrospectively collected data of patients diagnosed with neurological disorders associated with recreational use of N2O in Shengjing Hospital of China Medical University from January 2018 to June 2019, and performed a literature search using the “nitrous oxide” and “neurological disorder” as keywords in the Chinese literature databases of WANFANG and CNKI and the English literature databases of Pubmed and Web of Science

Results

We enrolled 43 patients (average age: 21.9 ± 3.3 years). The main clinical manifestations were weakness and paresthesia in the four extremities and unsteady gait. Further, most patients showed significantly lower levels of serum vitamin B12 (169.4 ± 79.1 pg/mL) and increased homocysteine levels (78.1 ± 32.2 μmol/L). MRI of the spinal cord showed longitudinal high T2 signal lesions in the dorsal spinal cord in some patients. Moreover, electromyography showed sensory and motor nerve axonal damage combined with demyelination, which was relatively more severe in the lower limbs. There was rapid improvement of the symptoms after treatment with intramuscular injections of vitamin B12 and the overall prognosis was good. The literature search indicated that the number of published papers and related patients showed a rapid annual increase since the first Chinese case reported in 2016

Conclusion

Recreational use of N2O is an emerging public health problem in China that needs prompt action from the society and government. Early diagnosis and treatment allow a good overall prognosis.

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Acknowledgements

We thank all of the subjects and medical staff for their assistance with this study.

Funding

Data collection, analysis, and interpretation of the study were supported by grants from the Natural Science Foundation of Liaoning Province (Grant No. 2018225091).

Author information

Author notes

  1. Dongming Zheng and Fang Ba contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Shengjing Hospital of China Medical University, Sanhao Street 36, Shenyang, 110004, Liaoning, China

    Dongming Zheng, Guorong Bi, Yang Guo, Yan Gao & Weishuai Li

  2. Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China

    Fang Ba

Authors
  1. Dongming Zheng
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  2. Fang Ba
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  4. Yang Guo
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Contributions

Conceptualization, FB, DMZ and WSL; data collection, analysis and investigation, GRB, YG (Yang Guo), YG (Yan Gao); writing (original draft preparation), FB, and DMZ; writing (review and editing), WSL. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Weishuai Li.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

This study was approved by the Ethics Committee of Affiliated Shengjing Hospital of China Medical University. All patients or the patient’s next-of-kin provided written informed consent to participate if a patient could not sign due to disability or underage. And this was also approved by the ethics committee. A copy of the written consent is available for review by the Editor of this journal.

Written informed consent

Written informed consent was obtained from the patients for publication of this research and any accompanying images or from the patient’s next-of-kin.

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Zheng, D., Ba, F., Bi, G. et al. The sharp rise of neurological disorders associated with recreational nitrous oxide use in China: a single-center experience and a brief review of Chinese literature. J Neurol 267, 422–429 (2020). https://doi.org/10.1007/s00415-019-09600-w

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  • DOI: https://doi.org/10.1007/s00415-019-09600-w

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