The Inhibited Pathway caused by N2O, leading to a decrease in the active form of Vitamin B12 and an increase in homocysteine and methionine.

Chronic abuse of N2O can lead to numerous neurological effects including ataxia, polyneuropathy, and psychosis. The neurological effects are due to its inhibition of vitamin B12.   
 - Vitamin B12 is an important cofactor needed for methionine synthase.  N2O converts vitamin B12 into its inactive form, via oxidation of its central cobalt ion. This leads to the irreversible inhibition of methionine synthase. 
 - Methionine synthase is a key enzyme in the production of DNA, RNA, and myelin. This eventually leads to demyelination in the central and peripheral nervous system.
 - Chronic use of N2O can cause a syndrome identical to subacute combined degeneration of the spinal cord, which is described in patients with vitamin B12 deficiency. The classic clinical picture of pernicious anemia includes bone marrow depression and polyneuropathy (dorsal (posterior) and lateral spinal column demyelination).


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