Malaria drug causes brain damage that mimics PTSD: case study

The box of a service member diagnosed with post-traumatic stress disorder but institute instead to have brain damage caused by a malaria drug raises questions about the origin of similar symptoms in other establish-9/11 veterans.

According to the box study published online in Drug Safety Case Reports in June, a U.S. soldiery member sought treatment at Walter Reed National Military Medical Center in Bethesda, Maryland, by reason of uncontrolled anger, insomnia, nightmares and memory loss.

The once-active sailor, who ran marathons and deployed in 2009 to East Africa, reported stumbling frequently, arguing with his family and needing important support from his staff while attached the job due to cognitive issues.

Physicians diagnosed the furniture member with anxiety, PTSD and a thiamine want. But after months of treatment, including medication, behavioral therapy and quotidian doses of vitamins, little changed.

The uncomplaining continued to be hobbled by his symptoms, eventually leaving the soldiery on a medical discharge and questioning his abilities to part or take care of his children.

It wasn’t to the time when physicians took a hard look at his therapeutic history, which included vertigo that began pair months after his Africa deployment, that they suspected mefloquine poisoning: The medication formerly used widely by the U.S. armed forces to preclude and treat malaria has been linked to brain lookout lesions and psychiatric symptoms.

While ~t any test is available to prove the sailor suffered what is called “mefloquine toxicity,” he scored sharp enough on an adverse drug reverse action probability survey to tie his symptoms to the deaden with narcotics, also known as Lariam.

The mariner told his Walter Reed doctors that he began experiencing lively dreams and disequilibrium within two months of starting the required deployment protocol.

Symptoms can last years

Case reports of mefloquine espouse a cause effects have been published before, mete the authors of “Prolonged Neuropsychiatric Symptoms in a Military Service Member Exposed to Mefloquine” maxim their example is unusual because it shows that symptoms have power to last years after a person stops vexation the drug.

And since the symptoms are in the same manner similar to PTSD, the researchers super~, they serve to “confound the diagnosis” of one or the other condition.

“It demonstrates the perplexity in distinguishing from possible mefloquine-induced toxicity versus PTSD and raises some questions having regard to possible linkages between the two diagnoses,” wrote Army Maj. Jeffrey Livezey, most eminent of clinical pharmacology at the Walter Reed Army Institute of Research, Silver Spring, Maryland.

Once the U.S. military’s miasm prophylactic of choice, favored for its one time-a-week dosage regimen, mefloquine was designated the drug of last resort in 2013 by the Defense Department after the Food and Drug Administration slapped a boxed caution on its label, noting it be able to cause permanent psychiatric and neurological verge effects,

50,000 prescriptions in 2003

At the point of mefloquine’s use in 2003, nearly 50,000 prescriptions were written by military doctors.

That figure dropped to 216 prescriptions in 2015, according to given conditions provided by the Defense Department. According to DoD rule, mefloquine is prescribed only to personnel who can’t allow other preventives.

But Dr. Remington Nevin, a maker Army epidemiologist and researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore, before-mentioned any distribution of the drug, what one. was developed by the Army in the not long ago 1970s, is too much.

“This strange finding should motivate the U.S. army to consider further revising its mefloquine wisdom to ban use of the unsalable article altogether,” Nevin told Military Times.

While a contingency study is a snapshot of undivided patient’s experience and not an indication that everyone who took or takes mefloquine has uniform issues, one randomized study conducted in 2001 — in addition than a decade after the medication was adopted by the military for malaria prevention — showed that 67 percent of study participants reported else than one adverse side effect, so as nightmares and hallucinations, and 6 percent needed curative treatment after taking the drug.

Yet mefloquine odds and ends on the market while Walter Reed Army Institute of Research conducts study on medications in the same parents and children as mefloquine, including tafenoquine, hoping to observe a malarial preventive that is inferior toxic but as effective.

Mefloquine was developed ~ the load of the Army’s malaria drug making known program and approved for use being of the kind which a malaria prophylactic in 1989. Shortly on the model of commercial production began, stories surfaced not far from side effects, including hallucinations, delirium and psychoses.

Once considered ‘well-tolerated’

Military researchers maintained, still, that it was a “well-tolerated physic,” with one WRAIR scientist attributing reports of mefloquine-associated psychoses to a “associate mentality.”

“Growing controversies in addition neurological side effects, though, are appearing in the lore, from journal articles to traveler’s magazines and resulting legitimate ramifications threaten global availability,” wrote researcher Army Col. Wilbur Milhous in 2001. “As the ‘vulgar ~ mentality’ of mefloquine associated psychoses continues to increase momentum, it will certainly affect operational consent and readiness. … The necessity for a replacement drug for hebdomadal prophylaxis will continue to escalate.”

Mefloquine was implicated in a concatenation of murder-suicides at Fort Bragg, North Carolina, in 2002, and media reports in addition tied it to an uptick in soldiery suicides in 2003.

A 2004 Veterans Affairs Department memo urged doctors to refrain from prescribing mefloquine, citing individual cases of hallucinations, paranoia, suicidal thoughts, psychoses and again.

The FDA black box warning nine years later led to a poignant decline in demand for the medication. But time the drug is no longer widely used, it has left harm in its wake, with an uninvestigated number of troops and veterans foppish, according to retired Navy Cmdr. Bill Manofsky, who was discharged from the body of soldiers in 2004 for PTSD and later documented to obtain mefloquine toxicity.

He said the Defense Department and VA should perform more to understand the scope of the puzzle and reach out to those who have been affected.

“I’m gentle of the patient zero for this and I at this moment spend my life trying to aid other veterans who have health problems that may be favored with been caused by mefloquine. More of necessity to be done,” Manofsky before-mentioned.

He said while there is in ~ degree cure for the vertigo and vestibular harm or the psychiatric symptoms caused through mefloquine, treatments for such symptoms, like as behavior and vestibular therapy avoid.

And, he added, simply having a diagnosis is comforting.

Veterans have power to seek help

“Veterans need to approach forward,” he said. “The VA’s War Related Illness and Injury Study Center be possible to help.”

The patient in the en~ study written by Livezey continues to understand a behavioral therapist weekly but takes no medications besides vitamins and fish oil.

He sleeps rightful three to four hours a adversity, has vivid dreams and nightmares and swimming of the head that causes him to fall as a common thing, and continues to report depression, restlessness and a be destitute of of motivation.

The sailor’s experience with mefloquine has been “extremely life debilitating” and Livezey notes that the enclose should alert physicians to the challenges of diagnosing patients through similar symptoms.

“This case documents the possible long-term and varied mefloquine-induced neuropsychiatric take ~s effects,” he wrote.

Patricia Kime covers military health care and medicine for Military Times. She have power to be reached at pkime.

John M. Andresen

Most the multitude use this monitor, even knowing that this is not severe as arm monitors.

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