Neurophysiological Characteristics of Nitrous Oxide-Induced Polyneuropathy: A Case Series

IF 3 3区医学 Q1 CLINICAL NEUROLOGY

Journal of the Peripheral Nervous System Pub Date : 2026-07-31 DOI:10.1111/jns.70156

Tanya Elisabeth Bentley, Volker Limmroth, Maximilian Zimmermann, Johannes Fabian Holle

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引用次数: 0

Abstract

Background

Nitrous oxide (N₂O) misuse is a growing health concern, with N₂O-induced neurological disorders increasingly reported across Europe. Among these, N₂O-induced polyneuropathy (PNP) can lead to permanent deficits, yet its neurophysiological characteristics remain inconsistently described. This retrospective case series aimed to characterize the electrophysiological pattern of N₂O-induced polyneuropathy.

Methods

We reviewed the records of 12 patients with acute neurological symptoms and a history of N₂O abuse, all of whom underwent electrophysiological testing at a German tertiary care hospital between July 2023 and December 2024. Data were analyzed descriptively.

Results

Conduction studies revealed evidence of PNP in eight out of 12 patients and the most common pattern was pure motor (5/8). No distinct clinical phenotype could be identified for patients with electrophysiologically confirmed PNP or Pure-Motor PNP. SSEPs were abnormal in all assessable patients, whereas signs of SCD on MRI were present in a smaller proportion. Only three of 10 tested patients had reduced vitamin B12 levels, while all showed elevated methylmalonic acid (MMA) levels. Mean MMA levels were higher in patients with PNP than in those without.

Interpretation

The reason why N₂O leads to different patterns of PNP remains unclear and a distinct phenotype for N₂O-induced PNP or Pure-Motor PNP was not found in this cohort. MMA represents a more reliable biomarker than serum vitamin B12 in the diagnostic workup of N₂O-induced neurotoxicity. These findings highlight the need for further research into additional neurotoxic properties of N₂O and individual predisposing factors underlying the different electrophysiological patterns of N₂O-induced PNP.

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一氧化二氮诱导的多发性神经病的神经生理特征：一个病例系列

一氧化二氮（N2O）滥用是一个日益严重的健康问题，在欧洲越来越多地报道了由N2O引起的神经系统疾病。其中，n2o诱导的多神经病变（PNP）可导致永久性缺陷，但其神经生理特征的描述仍不一致。本回顾性病例系列旨在描述n2o诱导的多发性神经病的电生理模式。方法回顾了2023年7月至2024年12月在德国一家三级医院接受电生理检查的12例有急性神经症状和N2O滥用史的患者的记录。对数据进行描述性分析。结果12例患者中有8例出现PNP，最常见的是纯运动模式（5/8）。电生理学证实的PNP或纯运动性PNP患者没有明确的临床表型。在所有可评估的患者中，ssep都异常，而MRI上出现SCD迹象的比例较小。10名接受测试的患者中只有3名维生素B12水平降低，而所有患者的甲基丙二酸（MMA）水平均升高。PNP患者的平均MMA水平高于无PNP患者。N2O导致不同类型PNP的原因尚不清楚，在该队列中未发现N2O诱导的PNP或纯运动PNP的明显表型。在n2o诱导的神经毒性诊断中，MMA是比血清维生素B12更可靠的生物标志物。这些发现强调需要进一步研究N2O的其他神经毒性特性以及N2O诱导的PNP不同电生理模式下的个体易感因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the Peripheral Nervous System 医学-临床神经学

CiteScore

6.10

自引率

7.90%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of the Peripheral Nervous System is the official journal of the Peripheral Nerve Society. Founded in 1996, it is the scientific journal of choice for clinicians, clinical scientists and basic neuroscientists interested in all aspects of biology and clinical research of peripheral nervous system disorders. The Journal of the Peripheral Nervous System is a peer-reviewed journal that publishes high quality articles on cell and molecular biology, genomics, neuropathic pain, clinical research, trials, and unique case reports on inherited and acquired peripheral neuropathies. Original articles are organized according to the topic in one of four specific areas: Mechanisms of Disease, Genetics, Clinical Research, and Clinical Trials. The journal also publishes regular review papers on hot topics and Special Issues on basic, clinical, or assembled research in the field of peripheral nervous system disorders. Authors interested in contributing a review-type article or a Special Issue should contact the Editorial Office to discuss the scope of the proposed article with the Editor-in-Chief.