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Treatment of Sarin Exposure—Reply
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In Reply: I agree with Dr Krivoy and colleagues that a search is underway for an alternative or adjunct to diazepam as an antiseizure treatment. Shih and McDonough1 have shown that its effectiveness is decreased when administered 40 minutes after seizure onset. However, in another study McDonough et al2 also found that diazepam was the most potent compound when administered 40 minutes after seizure onset compared with 8 anticholinergic drugs, including benactyzine.
Wood and Tattersall3 found that NMDA antagonists AP5 and MK-801 failed to block second population of spikes and spontaneous discharges induced by the nerve agent soman. Their results are consistent with the reported lack of effectiveness of NMDA antagonists in other seizure models. In some cases, the NMDA antagonists had a proconvulsant effect.
Koplovitz et al4 found that a combination of diazepam and an anticholinergic drug was very effective in terminating soman-induced seizures, regardless of whether treatment is . . . [Full Text of this Article]
Maj Ernest C. Lee, MD, MPH, USAF, MC
Occupational and Environmental Medicine
Harvard School of Public Health
Boston, Mass
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