Longitudinal follow-up and prognostic factors in nitrous oxide-induced neuropathy

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY Journal of the Peripheral Nervous System Pub Date : 2024-05-21 DOI:10.1111/jns.12634

Etienne Fortanier, Emilien Delmont, Giovanni Corazza, Ludivine Kouton, Joelle Micallef, Shahram Attarian

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Abstract

Background and Aim

Recreational use of nitrous oxide (N₂O) has been associated with the development of severe nitrous oxide-induced neuropathy (N₂On). Follow-up of these patients poses challenges, and their clinical progression remains largely unknown. The identification of prognostic factors is made difficult by the lack of standardized longitudinal assessments in most studies. The objective was to document the course of neuropathy through systematic follow-up assessments in N₂On patients to identify prognostic factors for persistent disability after 6 months.

Methods

We gathered demographic, clinical, biological, and electrophysiological data from N₂On patients hospitalized in the Referral center in Marseille, both at baseline and during a standardized follow-up assessment at 6 months.

Results

We retrospectively included 26 N₂On patients (mean age 22.6 ± 4.4). Significant improvements were observed in all main clinical scores including Rankin, ONLS, and MRC testing (p < .01). Electrophysiological studies (EDX) revealed a predominantly motor neuropathy with marked reduction in CMAP in the lower limbs at baseline, and no significant improvement in motor parameters (p = .543). Rankin score at 6 months correlated with the initial weekly N₂O consumption (r = .43, p = .03) and the CMAP sum score in the lower limbs at the first EDX (r = −.47, p = .02). Patients with and without myelitis showed similar Rankin and ONLS score after 6 months.

Interpretation

The clinical course generally improved favorably at 6 months with notable amelioration in the primary disability scores, sensory deficits, and ataxia. However, distal motor impairment associated with peripheral neuropathy persisted, with distal axonal loss emerging as the main prognostic factor for long-term disability in these young patients.

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一氧化二氮诱发神经病的纵向随访和预后因素。

背景和目的：娱乐性使用一氧化二氮（N2O）与严重的一氧化二氮诱发神经病变（N2On）的发生有关。对这些患者进行随访是一项挑战，他们的临床进展情况在很大程度上仍不为人所知。由于大多数研究缺乏标准化的纵向评估，因此很难确定预后因素。我们的目的是通过对 N2On 患者进行系统的随访评估来记录神经病变的过程，从而确定 6 个月后持续残疾的预后因素：我们收集了在马赛转诊中心住院的 N2On 患者在基线和 6 个月标准化随访评估期间的人口统计学、临床、生物学和电生理学数据：我们回顾性地纳入了 26 名 N2On 患者（平均年龄为 22.6 ± 4.4）。在所有主要临床评分中，包括 Rankin、ONLS 和 MRC 测试（p 2O 消费）（r = .43，p = .03）以及首次 EDX 时下肢 CMAP 总分（r = -.47，p = .02），均观察到明显改善。6个月后，有脊髓炎和没有脊髓炎的患者显示出相似的 Rankin 和 ONLS 评分：6个月后，临床症状普遍得到改善，主要残疾评分、感觉障碍和共济失调明显改善。然而，与周围神经病变相关的远端运动障碍依然存在，远端轴突缺失成为这些年轻患者长期残疾的主要预后因素。

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.