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January 14, 2004

Treatment of Sarin Exposure

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(2):181. doi:10.1001/jama.291.2.181-a

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, γ-aminobutyric acidergic) systems.

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