Letters

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 mechanisms of autistic disorders are not completely understood. At least one kind of autism (Heller's dementia) is clinically quite similar to Alzheimer's disease.

No specific drugs seem to improve autism significantly. Desipramine, dextroamphetamine, clonidine, neuroleptics, and methylphenidate are 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 investigating the 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 revised Wechsler intelligence scale for children). They were without medical or neurological illnesses, had autistic disorder diagnosed by ICD-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 inadequate for their developmental level.

When parent and teacher scores were combined, mean scores were slightly lower during treatment with galantamine than during treatment with placebo for irritability classified by ratings of 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 significantly different between galantamine and placebo.

None of the subjects seemed to have headaches or stomach aches, although the reporting of such side effects was limited by participants' expressive language and social skills.

Galantamine seems to be not only effective in treating Alzheimer's disease but may also be also moderately effective in the short term treatment of irritability in children with autistic disorder.

Helmut Niederhofer, child and adolescent psychiatrist. 
Regional Hospital of Bolzano, Department of Paediatrics, Via L Boehler, 5, I-39100 Bolzano, Italy helmut.niederhofer{at}uibk.ac.at

W Staffen, neurologist. 
A Mair, neurologist. 
Christian Doppler Klinik, Department of Neurology, Ignaz-Harrer Strasse 79, A-5020 Salzburg, Austria