{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:47:32Z","timestamp":1784634452353,"version":"3.55.0"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T00:00:00Z","timestamp":1691366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recreational use of nitrous oxide (N<jats:sub>2<\/jats:sub>O) has dramatically increased in recent years, resulting in numerous cases of acute sensorimotor tetraparesis secondary to nitrous oxide\u2010induced neuropathy (N<jats:sub>2<\/jats:sub>On). Challenging clinical features can mimic Guillain\u2010Barr\u00e9 syndrome (GBS), the main differential diagnosis upon admission. The most sensitive biomarkers for distinguishing between these two conditions remain to be determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty\u2010eight N<jats:sub>2<\/jats:sub>On patients from three referral centers were retrospectively included over a 2\u2010year period and compared to GBS patients hospitalized during the same timeframe (47 patients). Collected demographic, clinical, biological, and electrophysiological data were compared between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The typical N<jats:sub>2<\/jats:sub>On clinical pattern included distal sensorimotor deficit in lower limbs with absent reflexes, proprioceptive ataxia, and no cranial involvement (56.7% of our cohort). Misleading GBS\u2010like presentations were found in 14 N<jats:sub>2<\/jats:sub>On patients (24.1%), and 13 patients (22.4%) did not report N<jats:sub>2<\/jats:sub>O use during initial interview. Only half the N<jats:sub>2<\/jats:sub>On patients presented with reduced vitamin B12 serum levels upon admission. A slightly increased cut\u2010off (&lt;200\u2009pmol\/L) demonstrated 85.1% sensitivity and 84.5% specificity in distinguishing N<jats:sub>2<\/jats:sub>On from GBS. Only 6.9% of N<jats:sub>2<\/jats:sub>On patients met the criteria for primary demyelination (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), with only one presenting conduction blocks. A diagnostic algorithm combining these two biomarkers successfully classified all GBS\u2010like N<jats:sub>2<\/jats:sub>On patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vitamin B12 serum level\u2009&lt;\u2009200\u2009pmol\/L cut\u2010off and conduction blocks in initial electrophysiological study are the two most sensitive biomarkers for rapidly distinguishing N<jats:sub>2<\/jats:sub>On from GBS patients. These two parameters are particularly useful in clinically atypical N<jats:sub>2<\/jats:sub>On with GBS\u2010like presentation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15998","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T17:24:28Z","timestamp":1690392268000},"page":"3296-3306","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["How to distinguish Guillain\u2010Barr\u00e9 syndrome from nitrous oxide\u2010induced neuropathy: A 2\u2010year, multicentric, retrospective study"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2797-9389","authenticated-orcid":false,"given":"Etienne","family":"Fortanier","sequence":"first","affiliation":[{"name":"Reference Center for Neuromuscular Diseases and ALS La Timone University Hospital, Aix\u2010Marseille University  Marseille 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