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August 2019; 9 (4) Review

Therapy for acute nerve agent poisoning

An update

Jonathan Newmark
First published April 23, 2019, DOI: https://doi.org/10.1212/CPJ.0000000000000641
Jonathan Newmark
Department of Neurology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology, School of Medicine and Health Sciences, George Washington University; and Department of Neurology, Washington DC Veterans' Affairs Medical Center.
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Therapy for acute nerve agent poisoning
An update
Jonathan Newmark
Neurol Clin Pract Aug 2019, 9 (4) 337-342; DOI: 10.1212/CPJ.0000000000000641

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Abstract

Purpose of review Acute nerve agent poisoning was last reviewed in the neurology literature in 2004. As neurologists may expect to be called upon by non-neurologist colleagues as local experts, it is timely to update the 2004 review.

Recent findings Acute antidotal therapy for nerve agent poisoning has been rendered simpler and faster by the FDA approval and introduction of the dual-dose autoinjector. Although there are no truly new fielded antidotes, midazolam recently received FDA approval for treatment against seizures, and will replace diazepam in most acute situations when the FDA approves it in the autoinjector form. Information on acute therapy is much more easily accessed in real time now than in 2004, thanks to efforts by the National Library of Medicine and the American College of Medical Toxicology.

Summary Since 2004, there have been changes in antidotal therapy and a robust expansion in familiarity with nerve agent management principles in the civilian sector. These advances are somewhat offset by the increased use of nerve agents for nefarious purposes.

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  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Received October 23, 2018.
  • Accepted February 1, 2019.
  • © 2019 American Academy of Neurology
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