From the Research
The treatment approach for neurological symptoms associated with nitrous oxide addiction primarily involves immediate cessation of N2O use and high-dose vitamin B12 supplementation, as supported by the most recent study 1. The goal of treatment is to address the underlying vitamin B12 deficiency, which is caused by N2O's inactivation of vitamin B12, leading to demyelination of nerves, particularly in the posterior and lateral columns of the spinal cord.
- Patients typically receive intramuscular hydroxocobalamin or cyanocobalamin injections at 1000-2000 mcg daily for 1-2 weeks, followed by weekly injections for several months until symptoms resolve, as described in the study 1.
- This is often accompanied by oral B12 supplementation at 1000-2000 mcg daily.
- Folate (5 mg daily) and methionine supplementation may also be beneficial, as suggested by the study 2.
- Physical therapy and rehabilitation are important components of treatment, especially for patients with significant motor deficits or ataxia.
- Pain management may be necessary for neuropathic pain using medications such as gabapentin (300-1200 mg three times daily) or pregabalin (75-300 mg twice daily), as mentioned in the study 3.
- Addressing the underlying addiction is crucial through psychological counseling, addiction treatment programs, and sometimes psychiatric evaluation for co-occurring mental health conditions. The study 4 highlights the importance of early treatment, as prolonged B12 deficiency can cause permanent neurological damage. It is essential to note that N2O abuse can cause unique axonal dysfunction, different from that of vitamin B12 deficiency, as suggested by the study 2. Overall, the treatment approach should prioritize immediate cessation of N2O use, high-dose vitamin B12 supplementation, and addressing the underlying addiction, as supported by the most recent and highest-quality study 1.