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Cycling protocols of four to six weeks on, four to six weeks off align with the biology of connective tissue repair and represent a conservative default in the absence of long-term human safety data

Initial clinical assessment should include a thorough neurological examination documenting: Sensory testing for vibration sense (using a 128 Hz tuning fork) and proprioception Assessment of gait and coordination (Romberg's test) Evaluation of reflexes and muscle tone Cognitive screening if indicated Fundoscopy if visual symptoms are present History of nitrous oxide exposure (recreational or occupational) Laboratory investigations recommended in UK practice include: Serum B12 level whilst the standard first-line test, interpretation requires caution

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