Page 74 - JSOM Winter 2023

requires a level of expertise that might not always be available become tightly fastened and a change in the structure of the
to non-state actors. protein complex occurs. This process is known as aging and is
an important factor in determining the correct course of treat-
ment for nerve agent exposure. 48
Chemical Neuroweapons
Careful observation of the natural world led to the discov- An incapacitating agent known as BZ was developed and wea-
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ery of abiotic toxic compounds. These agents were applied to ponized by the U.S. government during the Cold War. BZ is
hunting and warfare as early as the Paleolithic era (approxi- a powerful anticholinergic that produces a toxidrome of delir-
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mately 12,000 years ago). Early hunters took advantage of ium, vasodilation, xerostomia, hyperthermia, and mydriasis.
the neurotoxic effects of plant alkaloids, such as strychnine Exposure to BZ results in incapacitating altered mental states,
(spastic convulsant), aconitine, toxiferine I (paralytic), and including cognitive dysfunction, hallucinations, and the inabil-
tubocurarine to increase the effectiveness of their arrows and ity to perform basic tasks. It was weaponized by the U.S. Army
spears in Europe, Asia, and South America. These compounds as an aerosolized incapacitating agent. A similar anticholin-
would eventually be found with plant alkaloids in the battle ergic agent has been allegedly developed and weaponized by
for Kirrha during the First Sacred War in the sixth century the governments of Iraq and Syria. Deployment of this agent
B.C. They were also used by the Scottish who poisoned the in- or similar agents in future conflicts remains a possibility and
vading Norwegian army’s food in the 11th century and in the should be prepared for.
development of toxin-filled grenades, specialized toxin-filled
ammunition in small arms, and the production of toxin-con- Directed Energy Neuroweapons
taining bombs during the industrial era. 34
While it is well known that ionizing radiation such as gamma
The chemical revolution of the 19th century opened the door rays and X-rays have sufficient energy to break chemical
to the development of synthetic neurotoxins that could be bonds and damage DNA, exposure to non-ionizing forms of
produced at industrial scales and applied to modern warfare. radiation can also have biological effects. However, this type
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For example, the organophosphate tabun was noted to be of energy primarily tends to cause injury through thermal ex-
extremely toxic to humans, and, although it was initially de- citation mechanisms and subtle interactions with cellular bio-
veloped as an industrial insecticide, it was manufactured as a chemistry. Safety limits on exposure times and doses have
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neuroweapon and used during the Iran-Iraq War. Exposure been established by government agencies mainly to protect
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to this agent resulted in increased acetylcholine circulation and against the possibility of unintentional tissue heating. Expo-
global activation of neurons, leading to the classic toxidrome sure to non-ionizing radiation within safety limits is widely
of excessive secretions, respiratory distress, and paralysis that considered to be safe. However, numerous studies have shown
is now described with the acronym DUMBELS (defecation, uri- that auditory, behavioral, and physiological responses can re-
nation, muscle weakness, miosis, bradycardia, bronchospasm, sult from exposure to specific frequencies and wavelengths. 54,55
bronchorrhea, emesis, lacrimation, and salivation). Similar Recent studies on pulsed radiofrequency effects on the ner-
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agents were quickly identified, and these led to the develop- vous system in animal models and humans indicate that it is
ment and production of the G series of nerve agents tabun both plausible and possible that this form of energy can be
(GA), sarin (GB), chlorosarin (GC), soman (GD), ethylsarin employed as a neuroweapon. 56–58 Interestingly, a review of the
(GE), and cyclosarin (GF) for military use during World War relevant literature indicates that pulsed low-intensity radio-
II (WWII). After WWII, further research into nerve agents frequency and microwave radiation can produce a series of
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produced the V series of agents (of which VX is most well- symptoms such as headache, fatigue, dizziness, irritability,
known), novichok, and the carbamate nerve agents. 38 anxiety, forgetfulness, impaired concentration, and internal
sound perception in affected personnel. 57 While the exact
Tabun, sarin, soman, cyclosarin, and VX are the most toxic mechanism of these symptoms has not been determined, there
nerve agents that have been developed to date and are the is evidence to suggest that internal sound perception can be
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most likely agents to be employed in combat. However, the generated from radiofrequency or microwave exposure by the
only battlefield use of nerve agents occurred during the Iran- conversion of electromagnetic waves to thermoacoustic waves
Iraq War when Iraqi forces are suspected to have exposed the and that these disturbances can be mechanically transmitted
village of Halabja to chemical agents, which may have in- through the head and detected by the sensitive hairs of the
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cluded neurotropic compounds. 40,41 Historically, nerve agents cochlea. It is significant to note that symptoms similar to the
have been used by state and non-state actors during terrorist neurological complaints that were reported by both American
acts or in assassination attempts. For example, sarin was used and Canadian diplomats suffering from Havana syndrome in
in multiple terrorist attacks by the Japanese doomsday cult Cuba and China between 2016 and 2018 can be reproduced
known as Aum Shinrikyo in the 1990s, VX gas was reported by radiofrequency or microwave exposure in the laboratory
to have been used by North Korean agents in the assassination setting. 60,61 It is also significant that many of the affected per-
of Kim Jong-Nam in 2017, and novichok was used in the poi- sonnel developed chronic symptoms requiring neurocognitive
soning of Sergei and Yulia Skripal by the Russian government testing and diagnostic imaging, which demonstrated multiple
in 2018. 42–46 functional and structural impairments. These impairments in-
cluded blood-brain barrier injury, abnormal paroxysmal slow-
Treatment of nerve agent exposure consists of decontamina- ing events of cortical activity, evidence of reduced fiber density
tion, ventilation, supportive care, and antidote therapy (at- in the fornix and the splenium, regional gray and white matter
ropine, pralidoxime, and diazepam). Early recognition and volume changes, and changes in the functional connectivity of
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treatment are critical owing to time-based properties that have the auditory and visuospatial subnetworks. Moreover, labo-
been observed with several nerve agents. Namely, antidotes ratory analyses of some of the victims indicated reduced levels
can become ineffective after the nerve agent and target protein of cholinesterase activity and the presence of organophosphate
72 | JSOM Volume 23, Edition 4 / Winter 2023