Prognosis. Damage to the synapse and thus the neuromuscular blockade is permanent. Recovery only occurs with the sprouting of a new axon, which reinnervates the paralyzed muscle fibers [15] . In adults, this process may require many weeks or months or as much as a year or longer [14] . After many months, the original neuromuscular junction may regain activity. If respiratory paralysis has resulted, the patient usually remains ventilator-dependent during the recovery period, usually for 2 to 8 weeks [82] . In the case of a bioterrorist attack, supplying large numbers of patients with intensive care and mechanical ventilation would present tremendous logistical problems [10] .