title: [Cognitive impairment due to intensive use and overdoses of gammahydroxybutyric acid (GHB)].
abstract: BACKGROUND
  In several countries, including the Netherlands, the use of GHB seems to be increasing. Many recreational users of GHB consider the drug to be harmless and to have no serious side effects. In recent years the number of patients with GHB addition has been increasing steadily.
  
  
  OBJECTIVE
  To draw attention to the possible development of neurotoxicity due to chronic and intensive use of GBH.
  
  
  METHODS
  We reviewed the literature using PubMed.
  
  
  RESULTS
  Several studies point to an increase in the number of incidents arising from the risky use of GHB or from a GHB overdose. Other drugs, such as ketamine and alcohol, are known to cause neurotoxicity, leading to cognitive impairment. As outlined in this review article, GHB , alcohol and ketamine show clear similarities in their mechanism of action. This suggests that GHB might have almost the same neurotoxic effects as ketamine and alcohol. An overdose of GHB, just like binge-drinking and a high dose of ketamine, may lead to a coma that probably harms the brain, particularly if comas occur repeatedly.
  
  
  CONCLUSIONS
  The risk of neurotoxicity is likely to increase with chronic, intensive use of GHB, which is a feature of GHB-addition. We therefore advocate research into the possible toxic effects of GHB in the long term, involving, for instance, the study of lasting effects on the cognitive functions of GHB users and former users.
authors.affiliation: jan.van.amsterdam@rivm.nl
authors.forename: J G C
authors.initials: JG
authors.lastname: van Amsterdam
authors.forename: T M
authors.initials: TM
authors.lastname: Brunt
authors.forename: M T B
authors.initials: MT
authors.lastname: McMaster
authors.forename: R
authors.initials: R
authors.lastname: Niesink
authors.forename: M S
authors.initials: MS
authors.lastname: van Noorden
authors.forename: W
authors.initials: W
authors.lastname: van den Brink
mesh_terms: D003071:Cognition / Q000187:drug effects*; D003128:Coma / Q000139:chemically induced*; D062787:Drug Overdose; D000431:Ethanol / Q000009:adverse effects; D006801:Humans; D006885:Hydroxybutyrates / Q000009:adverse effects*; D013287:Illicit Drugs / Q000009:adverse effects; D007649:Ketamine / Q000009:adverse effects*; D020258:Neurotoxicity Syndromes
chemical_list: D006885:Hydroxybutyrates; D013287:Illicit Drugs; C111420:4-hydroxybutyric acid; D000431:Ethanol; D007649:Ketamine