Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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.
Krivoy A, Layish I, Rotman E, Yehezkelli Y. Treatment of Sarin Exposure. JAMA. 2004;291(2):181. doi:10.1001/jama.291.2.181-a