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Brain injury tied to malaria drug, doctor says

Jun. 13, 2012 - 04:28PM   |   Last Updated: Jun. 13, 2012 - 04:28PM  |  
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An Army physician who spent his career studying the malaria drug mefloquine, also known as Lariam, asked Congress on June 6 to support research on brain injuries he says can be caused by the medication.

Speaking before the Senate Appropriations Committee, Maj. Remington Nevin requested funding for a mefloquine research center at a civilian medical or public health school to investigate the "physiology, epidemiology, clinical diagnosis and treatment" of health issues related to mefloquine.

"Given our research commitments to post-traumatic stress and traumatic brain injury … this observation calls for a similarly robust agenda into mefloquine neurotoxic brain injury to ensure that patients with these conditions are receiving accurate diagnoses and the very best medical care," Nevin said.

An epidemiologist and preventive medicine expert, Nevin published a case study in March of a sailor who developed psychosis, short-term memory loss, confusion and personality change after taking mefloquine. Nevin believes the drug caused lesions to form in the patient's brain stem.

He has published previous work similarly raising concerns about mefloquine, developed under the Army's malaria drug discovery program from 1963 to 1976 to prevent and treat malaria.

Anecdotal reports of severe mefloquine reactions abound, including one presented in May at the American Psychiatric Association meeting in Philadelphia by Army Maj. Jerald Block, who discussed the case of a previously normal soldier who developed psychoses while deployed to Afghanistan.

According to Block, the service member reported vivid dreams of a frightening dragon which later appeared to him during the daytime as the soldier cleaned his weapon.

Suspecting an adverse reaction to mefloquine, Block prescribed an alternative malaria therapy and the atypical antipsychotic quetiapine, or Seroquel, to halt the psychotic episodes.

The patient recovered.

The Pentagon's top doctor, Jonathan Woodson, in January directed the Army, Navy and Air Force and the commander of Joint Task Force National Capital Region Medical to provide their data and policies related to mefloquine prescriptions.

In the Defense Department, mefloquine is supposed to be a last-choice drug after doxycycline, chloroquine or Malarone, but it remains in use because it is taken weekly while the others are taken daily. Some physicians believe that troops are more likely to take a weekly dose.

DoD published a memo in 2009 saying doxycylcine and mefloquine may be used in areas where malaria is resistant to chloroquine, but doxycycline is the preferred choice.

In 2011, U.S. Central Command and U.S. Africa Command issued memos barring mefloquine use except when doxycycline or Malarone cannot be taken.

The drug first drew concerns in 2002, when it was noted that four soldiers who killed their wives had been taking mefloquine. Two of those troops committed suicide.

Concerns over the medication's side effects resurfaced in March, when a former Army psychiatrist listed it among the medications possibly taken by Army Staff Sgt. Robert Bales, charged in the shooting deaths of 16 Afghan civilians.

Nevin, who is on terminal leave from the Army and will pursue a research career at Johns Hopkins University, told appropriations committee members that while the damage caused by a toxic dose of mefloquine cannot be reversed, he believes research can improve the lives of those with brain damage.

"I have personally treated a number of patients whose conditions have proven fairly responsive to rehabilitation, including vestibular physical and neuro-optimetric therapy. Speech therapy and cognitive rehabilitation also hold promise.

"However, obtaining access to such therapy requires that mefloquine neurotoxic brain injury be correctly diagnosed," he said.

Last year, 124 service members contracted malaria 91 in Afghanistan, 24 in Africa and nine elsewhere. The year before, 113 troops contracted malaria; one died.

Nevin said his testimony was as a private citizen and that he did not speak for the Army.

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