Hashi Mohamoud, Smith Laura, Patyjewicz Marta, Onen Barbara, Mamigo Katrina, Adu-Poku Eunice, Fox Gillian, Noyce Alastair J
Wolfson Institute of Population Health, Queen Mary University of London, Centre for Preventive Neurology, London, England, UK.
Department of Neuology, Royal London Hospital, Barts Health NHS Trust, London, England, UK.
BMJ Neurol Open. 2025 Sep 3;7(2):e001234. doi: 10.1136/bmjno-2025-001234. eCollection 2025.
Nitrous oxide (N₂O)-related neurotoxicity is a significant public health concern among young people in the UK. Recognition necessitates timely diagnosis, abstinence from N₂O consumption and replacement of vitamin B12, usually via intramuscular (IM) hydroxocobalamin. This service development project evaluated a self-injection programme (SIP) compared with a nurse-led approach, within an established ambulatory care pathway, with the aim of improving treatment adherence and completion.
Between June and December 2024, a total of 46 patients presenting with N₂O-induced neurological symptoms were included in the evaluation. Patients were given the choice of self-injecting (SIP, n=25) or attending the hospital for nurse-led administration (non-SIP, n=21). Clinical outcomes, adherence and functional improvement (including the 10 metre walk test (10MWT)) were assessed.
Most patients were young (median age of 23), male (n=29, 63%), of Asian or Asian British ethnicity (n=29, 63%), and regularly using NO (n=32, 70%). SIP patients had higher adherence, missing fewer IM B12 doses compared with non-SIP (79.7% vs 20.3%, p<0.001). Clinical recovery rates were comparable, with 74% achieving full or substantial improvement across both groups. Walking speed (10MWT) improved across both groups following treatment and did not differ between groups.
Self-injection of IM hydroxocobalamin is a feasible and likely cost-effective alternative to nurse-led administration while maintaining clinical efficacy.
一氧化二氮（N₂O）相关神经毒性是英国年轻人中一个重大的公共卫生问题。要识别该问题需要及时诊断，停止使用N₂O，并补充维生素B12，通常通过肌肉注射（IM）羟钴胺素进行。这个服务开发项目在既定的门诊护理路径中，评估了一种自我注射方案（SIP）与护士主导方案相比的效果，目的是提高治疗依从性和完成率。
在2024年6月至12月期间，共有46名出现N₂O诱导神经症状的患者纳入评估。患者可选择自我注射（SIP组，n = 25）或到医院接受护士主导的注射（非SIP组，n = 21）。评估临床结果、依从性和功能改善情况（包括10米步行测试（10MWT））。
大多数患者年轻（中位年龄23岁），男性（n = 29，63%），亚裔或英裔亚裔（n = 29，63%），且经常使用N₂O（n = 32，70%）。SIP组患者依从性更高，与非SIP组相比，错过的IM B12注射剂量更少（79.7%对20.3%，p<0.001）。临床恢复率相当，两组中74%的患者实现了完全或大幅改善。两组治疗后步行速度（10MWT）均有所提高，且组间无差异。
自我注射IM羟钴胺素是一种可行且可能具有成本效益的替代方案，可替代护士主导的注射方式，同时保持临床疗效。
