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Treatment of Sarin Exposure
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To the Editor: In his article about symptoms and treatment of sarin intoxication, Dr Lee1 did not discuss some of the recent literature about neurotoxins. McDonough and Shih2 proposed a 3-phase model to explain the seizures and neuropathology observed in nerve agent toxicity. They propose that seizures are initiated by overstimulation of the cholinergic system (<5 minutes after seizure onset), followed by a transition phase (approximately 5-40 minutes after seizure onset) in which other excitatory neurotransmitter systems, mainly the glutmatergic system through the NMDA receptors, gradually predominates in maintaining the seizure activity. In the final phase (approximately 40 minutes postseizure-onset), the excitatory neurotransmitter system is the main trigger accounting for the continuum of seizures and neuropathology, overwhelming the inhibitory (eg,  -aminobutyric acidergic) systems.
Based on this hypothesis, treatment with a centrally acting anticholinergic agent such as scopolamine at the initial phase of seizures would be effective in decreasing the neural . . . [Full Text of this Article]
Amir Krivoy, MD;
Ido Layish, MD;
Eran Rotman, MD;
Yoav Yehezkelli, MD
Medical Corps
Israel Defense Forces
Tel Aviv
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