{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:48:38Z","timestamp":1790747318840,"version":"4.1.0"},"reference-count":47,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T00:00:00Z","timestamp":1677024000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015652","name":"Barts Charity","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015652","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2022,11,27]]},"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:p>\n                    Recreational use of nitrous oxide (N\n                    <jats:sub>2<\/jats:sub>\n                    O) has increased rapidly in recent years and is now the second most commonly used recreational drug among young people in the UK. There has been a corresponding rise in cases of nitrous oxide-induced subacute combined degeneration of the cord (N\n                    <jats:sub>2<\/jats:sub>\n                    O-SACD), a pattern of myeloneuropathy usually associated with severe vitamin B\n                    <jats:sub>12<\/jats:sub>\n                    deficiency. This can cause serious and permanent disability in young people but, if recognised early, may be effectively treated. All neurologists should be aware of N\n                    <jats:sub>2<\/jats:sub>\n                    O-SACD and its treatment; however, there are currently no agreed guidelines. Based on our experience in East London, an area of high N\n                    <jats:sub>2<\/jats:sub>\n                    O use, we provide practical advice on its recognition, investigation and treatment.\n                  <\/jats:p>","DOI":"10.1136\/pn-2022-003631","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T20:11:20Z","timestamp":1677096680000},"page":"222-228","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":60,"title":["Nitrous oxide-induced subacute combined degeneration of the cord: diagnosis and treatment"],"prefix":"10.1136","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8861-0334","authenticated-orcid":false,"given":"Alvar","family":"Paris","sequence":"first","affiliation":[{"name":"Preventive Neurology Unit, Centre for Prevention, Diagnosis and Detection, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK"},{"name":"Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Lake","sequence":"additional","affiliation":[{"name":"Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Joseph","sequence":"additional","affiliation":[{"name":"Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Workman","sequence":"additional","affiliation":[{"name":"Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Walton","sequence":"additional","affiliation":[{"name":"Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Hayton","sequence":"additional","affiliation":[{"name":"Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"},{"name":"Surgical Reconstruction and Microbiology Research Centre, National Institute for Health Research, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikos","family":"Evangelou","sequence":"additional","affiliation":[{"name":"Academic Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK"},{"name":"Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9230-4137","authenticated-orcid":false,"given":"James B","family":"Lilleker","sequence":"additional","affiliation":[{"name":"Muscle Diseases Unit, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Salford, UK"},{"name":"Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4662-2502","authenticated-orcid":false,"given":"Ruth M","family":"Ayling","sequence":"additional","affiliation":[{"name":"Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Nicholl","sequence":"additional","affiliation":[{"name":"Sandwell and West Birmingham NHS Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair J","family":"Noyce","sequence":"additional","affiliation":[{"name":"Preventive Neurology Unit, Centre for Prevention, Diagnosis and Detection, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK"},{"name":"Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"key":"2025090411363960000_23.3.222.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(78)92101-3"},{"key":"2025090411363960000_23.3.222.2","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/0165-6147(84)90426-7","article-title":"Interaction of nitrous oxide and vitamin B12","volume":"5","author":"Nunn","year":"1984","journal-title":"Trends Pharmacol Sci"},{"key":"2025090411363960000_23.3.222.3","doi-asserted-by":"crossref","first-page":"2886","DOI":"10.1039\/j19680002886","article-title":"Reactions of gases in solution. 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