Laughing gas can risk spine damage
As a result of a surge in laughing gas abuse experienced in East London, researchers from the Barts Charity-funded Preventive Neurology Unit (Centre for Preventive Neurology as of September 2023) based at the Royal London Hospital, have published new treatment guidelines for wider NHS use.
Nitrous oxide, sold in metal canisters, is one of the most commonly used drugs by 16 to 24-year-olds and can result in long-damage to the nervous system.
From recommendations published this month (23 February 2023), the diagnosis and treatment of spinal cord damage caused by nitrous oxide abuse have been simultaneously adopted as official clinical practice guidelines by the Association of British Neurologists.
Recreational use of nitrous oxide (also known as laughing gas) can lead to subacute combined degeneration of the spinal cord, a condition that can cause serious and permanent disability in young people. While it may be treated effectively if recognised early, it is commonly misdiagnosed and inappropriately treated. No agreed treatment guidelines have previously existed.
Symptoms to look out for
The new research is based on a project to improve diagnosis and treatment of nerve-related symptoms the Royal London Hospital, where they are treating a case almost every week. A large majority of patients present with inability to walk, falls, and tingling or loss of sensation in their feet and hands.
Other symptoms included weakness and bladder or bowel urgency or incontinence. Importantly, patients often do not mention nitrous oxide use, possibly because they do not connect it with their symptoms, or because they feel there is stigma associated with disclosing its use. Authors suggest that clinicians should be aware of the prevalence of nitrous oxide abuse in their local area, and make careful enquiries to determine whether nitrous oxide abuse may be causing the symptoms.
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“We developed these practical guidelines to try to standardise care for patients who have come to harm from recreational nitrous oxide use. If implemented correctly, they will ensure that patients get the treatment they need. We hope they will also alleviate pressure on hospitals by improving efficiency in the emergency department and reducing unnecessary admissions.”Senior author Alastair Noyce, Professor in Neurology and Neuroepidemiology at Queen Mary and Consultant Neurologist
Other important studies from the PNU
Findings from the PNU are now influencing the commissioning of dementia services in East London, addressing local healthcare inequalities so that people can get the care they need.
In the UK, around 900,000 people live with dementia – a number that is expected to rise sharply in the coming years. Early detection and prompt treatment could help delay the onset of dementia, helping people live longer in good health.
Historically, studies into dementia have underrepresented people from ethnic minority backgrounds and areas where people face more financial hardship. We need a better understanding of the risk of dementia in more diverse populations to develop ways to help everyone affected by the condition.
Dr Charles Marshall is a consultant neurologist and dementia expert at Barts Health NHS Trust and leads a programme of dementia research at the PNU. His team recently conducted the first dementia study to adequately represent a diverse UK population, involving more than a million people across East London. They found that both ethnicity and socio-economic deprivation are much more important risk factors for dementia than previously thought. This highlights the need to prioritise preventing dementia in these populations.
Thanks to funding from Barts Charity, our work in East London has shown that people from minoritised ethnic groups are at higher risk of dementia. These findings are now influencing policy and have obtained substantial follow-on funding.Dr Charles Marshall, Barts Health
How our funding is helping the PNU
Our £1.5 million investment in the PNU has allowed Dr Marshall to develop a new cognitive neurology service at Barts Health. Dr Marshall also works as a consultant at the East London Foundation Trust Diagnostic Memory Clinic in Tower Hamlets. This brings specialist dementia diagnoses to a population that didn’t have access to these important services before.