Veterans Affairs committee  I'm actually from the U.S.

Veterans Affairs committee  No, sorry.

Veterans Affairs committee  I know there are other chloroquines that are used routinely for things like rheumatoid arthritis or autoimmune disorders. What we look at there is macular toxicity. With some of those drugs, you've never heard of psychiatric issues with them. Mefloquine does seem to be somewhat u

Veterans Affairs committee  In those cranial nerves that are coming off the brain stem, the information is kind of flowing from the bottom. The eighth cranial nerve is your vestibular nucleus. Then the information comes up to the sixth, the fourth and the third, all of which involve coordinating your eye mu

Veterans Affairs committee  With any brain injury patient, we are looking very carefully at eye alignment. With the traditional eye exam. you don't really look at eye alignment very carefully. If they're not complaining of double vision, then you don't test out the fine details. There are techniques where

Veterans Affairs committee  I believe what I said was that there are no experts out there on mefloquine toxicity in vision. With regard to the visual consequences, the brain stem is an area where the vestibular system coordinates with the visual system in terms of keeping us balanced and helping us unders

Veterans Affairs committee  Yes, there are particular symptoms and signs that have shown up in the patients we see. A lot of it has to do with coordinating with the vestibular system. For instance, the patients we see with mefloquine toxicity that I'm aware of tend to have what we call vertical phorias, or

Veterans Affairs committee  No, not at all. Again, I'm not a mefloquine toxicity expert. The research that I saw was actually with rat studies. They just sectioned the brain stem so that they could see them under the microscope. I don't know if there is a way to tell in a human being if that is occurring.

Veterans Affairs committee  That's correct.

Veterans Affairs committee  I kind of owe an apology to Dr. Douglas and his colleagues in that I made it sound as if psych is not a huge part of treatment for the veterans or anybody with a brain injury. I think it's because psych is a place where people immediately turn. I wanted to emphasize what I think

Veterans Affairs committee  The research that I looked at was that there are micro-lesions that do not show up on imaging that can occur with quinolone use. Truthfully, again, as I said, I was asked to come because I have some cases of mefloquine toxicity in my practice and because I have expertise in the

Veterans Affairs committee  They came in previously diagnosed by other doctors. I believe they were mainly diagnosed by the neuro-otologists who saw them prior to their seeing us.

Veterans Affairs committee  These records, and I think—

Veterans Affairs committee  They were the clinical patient files.

Veterans Affairs committee  In the United States you only have to keep records for clinical patient files for three years after you see the patient if they're an adult. It's standard procedure to purge records after three or four years.