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

  • Figures

  • Tables

  • Summary

  • Acknowledgments

  • Abbreviations

  • Chapter One

    Introduction

  • Chapter Two

    Fact Sheet: PB Pretreatment for Soman Exposure

  • Chapter Three

    Characteristics of PB

  • Chapter Four

    PB Use in the Persian Gulf War

  • Chapter Five

    Health Problems in PGW Veterans

  • Chapter Six

    Theories Linking PB to Illness in Pgw Veterans

  • Chapter Seven

    Blood-Brain Barrier Passage

  • Chapter Eight

    Individual Differences in Reactions to PB

  • Chapter Nine

    Interactions Between PB and Other Exposures

  • Chapter Ten

    Bromism

  • Chapter Eleven

    Multiple Chemical Sensitivity

  • Chapter Twelve

    Neuromuscular Junction Effects

  • Chapter Thirteen

    Neurotransmitter Dysregulation

  • Chapter Fourteen

    Chronic Effects

  • Chapter Fifteen

    Other Considerations

  • Chapter Sixteen

    Conclusions

  • Addendum

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

  • Appendix A

    Pyridostigmine Pharmacokinetic Data

  • Appendix B

    Effects of PB in Humans

  • Appendix C

    Further Discussion of the Acetylcholine-Serotonin Relationship

  • References

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

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