Report
A Review of the Scientific Literature As It Pertains to Gulf War Illnesses: Pyridostigmine Bromide, Executive Summary
Jan 1, 1999
Volume 2: Pyridostigmine Bromide
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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.
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
This research was sponsored by the RAND National Security Research Division and RAND Health.
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