Nerve agents.
BACKGROUND
Nerve agents, the deadliest of the classic chemical warfare agents, primarily function as acetylcholinesterase inhibitors and cause a rapidly progressive cholinergic crisis. Originally developed for battlefield use, they have been used in terrorist attacks and are considered threats to the civilian population.


RESULTS
The pathophysiology and clinical presentation of acute nerve agent poisoning are summarized and acute treatment protocols reviewed. Timely support and antidotal treatment are crucial and may be lifesaving. Pyridostigmine bromide, recently approved by the Food and Drug Administration as a pretreatment for soman poisoning, forms part of battlefield doctrine but is unlikely to be used in the civilian sector. Aside from that, civilian recommendations for acute therapy derive, with only minor modifications, from military doctrine.


CONCLUSIONS
Neurologists should familiarize themselves with the pathophysiology and treatment principles for the syndromes caused by nerve agents, not only to assist with the hospital care of these patients but also to serve as resources to their local medical communities in preparation for chemical terrorism. Because nerve agents injure the nervous system, nonneurologists have a right to expect neurologists to have mastered these principles.
Newmark
Jonathan
J
Deputy Joint Program Executive Officer for Medical Systems, Joint Program Executive Office for Chemical/Biological Defense, Falls Church, Virginia 22041-3203, USA. jonathan.newmark@us.army.mil
D000818:Animals; D002619:Chemical Warfare Agents / Q000266:history / Q000506:poisoning*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D020258:Neurotoxicity Syndromes / Q000188:drug therapy / Q000209:etiology; D011729:Pyridostigmine Bromide / Q000627:therapeutic use
D002619:Chemical Warfare Agents; D002800:Cholinesterase Inhibitors; D011729:Pyridostigmine Bromide