Patients with disorders of consciousness who received high-frequency repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex, in addition to conventional therapy, were three times more likely to show improvement in consciousness level compared to those receiving only conventional therapy. The trial included 48 patients in a randomized controlled design. The stimulated group also showed better scores on a clinical global improvement scale and a reduction in a specific brain microstate (microstate E), suggesting the treatment may help restore balance among cerebral functional networks.
Chronic recreational nitrous oxide use can cause functional vitamin B12 deficiency and neuropsychiatric complications. In a review of 16 patients aged 17–25, all had neurological symptoms like limb numbness, unsteady gait, and weakness; 12 also had psychiatric symptoms including hallucinations, agitation, depression, and personality changes. Twelve patients had vitamin B12 deficiency, and all 16 had elevated homocysteine levels. Fourteen showed abnormal spinal cord signals on MRI. Symptoms improved with vitamin B12 treatment and stopping nitrous oxide use. Clinicians should recognize nitrous oxide as a cause of neuropsychiatric problems in young adults.