A Review of the Scientific Literature As It Pertains to Gulf War Illnesses

Volume 2: Pyridostigmine Bromide

by Beatrice A. Golomb


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The United States and its allies in the Persian Gulf War (PGW) knew that Iraq had used nerve agents and chemical weapons in its previous conflicts and so took steps to protect their troops. Pyridostigmine bromide (PB) was distributed as a pretreatment that would enhance the effectiveness of postexposure treatments in the event that the nerve agent soman was used. This report examines the role that PB played in the ongoing chronic health problems documented in PGW veterans. After careful examination of the known effects of PB on the central and peripheral nervous systems, the author finds the evidence consistent with a possible role for PB as a contributor to the health complaints of some PGW veterans and calls for immediate attention in the form of additional investigation to clarify the role of PB.

Table of Contents

  • Preface PDF

  • Figures PDF

  • Tables PDF

  • Summary PDF

  • Acknowledgments PDF

  • Abbreviations PDF

  • Chapter One

    Introduction PDF

  • Chapter Two

    Fact Sheet: PB Pretreatment for Soman Exposure PDF

  • Chapter Three

    Characteristics of PB PDF

  • Chapter Four

    PB Use in the Persian Gulf War PDF

  • Chapter Five

    Health Problems in PGW Veterans PDF

  • Chapter Six

    Theories Linking PB to Illness in Pgw Veterans PDF

  • Chapter Seven

    Blood-Brain Barrier Passage PDF

  • Chapter Eight

    Individual Differences in Reactions to PB PDF

  • Chapter Nine

    Interactions Between PB and Other Exposures PDF

  • Chapter Ten

    Bromism PDF

  • Chapter Eleven

    Multiple Chemical Sensitivity PDF

  • Chapter Twelve

    Neuromuscular Junction Effects PDF

  • Chapter Thirteen

    Neurotransmitter Dysregulation PDF

  • Chapter Fourteen

    Chronic Effects PDF

  • Chapter Fifteen

    Other Considerations PDF

  • Chapter Sixteen

    Conclusions PDF

  • Addendum

    Addendum: Evidence for Neurotransmitter Dysregulation Identified or Published Since the Review Process PDF

  • Appendix A

    Pyridostigmine Pharmacokinetic Data PDF

  • Appendix B

    Effects of PB in Humans PDF

  • Appendix C

    Further Discussion of the Acetylcholine-Serotonin Relationship PDF

  • References PDF

This research was sponsored by the RAND National Security Research Division and RAND Health.

This report is part of the RAND Corporation monograph report series. The monograph/report was a product of the RAND Corporation from 1993 to 2003. RAND monograph/reports presented major research findings that addressed the challenges facing the public and private sectors. They included executive summaries, technical documentation, and synthesis pieces.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.