Galantamine may be effective in treating autistic disorder
EDITORWilcock
et al report galantamine to be an effective and well tolerated drug in
Alzheimer's disease.1 The mechanismsof
autistic disorders are not completely understood. At leastone kind
of autism (Heller's dementia) is clinically quite similarto
Alzheimer'sdisease.
No specific drugs seem to improve autism significantly. Desipramine,
dextroamphetamine, clonidine, neuroleptics, and methylphenidateare
reported to be only slightly effective but also to have possible
severe adverse effects.2-4 We conducted a placebo
controlled,double blind crossover randomised controlled trial
investigatingthe efficacy of galantamine in autistic
disorders.
The participants were 20 boys attending an outpatient clinic (mean age
7.4 (SD 3.2) years; mean intelligence quotient (IQ)68 (11) on the
Leiter international performance scale of the revisedWechsler
intelligence scale for children). They were without medicalor
neurological illnesses, had autistic disorder diagnosed byICD-10
criteria, had been unsuccessfully treated with methylphenidate,
clonidine, desipramine, and neuroleptics for more than six weeks,and
had not received drug treatment for at least two weeks. Written
informed consent was obtained. Participants were included in the
study if their irritability, motor activity, eye contact, and
expressive language (maximum 10 word vocabulary) were inadequatefor
their developmentallevel.
When parent and teacher scores were combined, mean scores were slightly lower
during treatment with galantamine than duringtreatment with placebo
for irritability classified by ratingsof the aberrant behaviour
checklist5 (galantamine 11.5 (7.6)v
placebo 15.1 (5.4), P=0.039), hyperactivity (17.2 (12.8) v 21.7(15.4),
P=0.038), inadequate eye contact (placebo 7.6 (3.2) v
8.4 (5.2), P=0.049), and inappropriate speech (4.7 (3.1) v 6.2(2.4),
P=0.045).
Clinicians' scores of videotaped sessions using the modified children's
psychiatric rating scale for autism were not significantlydifferent
between galantamine andplacebo.
None of the subjects seemed to have headaches or stomach aches, although the
reporting of such side effects was limited byparticipants'
expressive language and socialskills.
Galantamine seems to be not only effective in treating Alzheimer's disease
but may also be also moderately effective in theshort term treatment
of irritability in children with autisticdisorder.
Helmut Niederhofer, child and adolescent
psychiatrist.
Regional Hospital of Bolzano, Department of Paediatrics, Via L Boehler,
5, I-39100 Bolzano, Italy
helmut.niederhofer@uibk.ac.at
W Staffen, neurologist. A Mair, neurologist.
Christian Doppler Klinik, Department of Neurology, Ignaz-Harrer Strasse
79, A-5020 Salzburg, Austria
Wilcock G, Lilienfeld S, Gaens E. Efficacy and safety of
galantamine in patients with mild to moderate Alzheimer`s disease:
multicentre randomised controlled trial. BMJ 2000; 321: 1445[Abstract/Free
Full Text].
Campbell M, Fish B, David R, Shapiro T, Collins P, Koh C.
Response to trijodothyronine and dextroamphetamine: a study of preschool
schizophrenic children. J Autism Child Schizophr 1972; 2: 943-955.
Campbell M, Adams P, Perry R, Speneer RK, Overall JE.
Tardive and withdrawal dyskinesia in autistic children: a prospective study.
Psychopharmacol Bull 1985; 24: 251-255.
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