Nerve agents

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.

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.

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.