Objective: To determine whether galantamine could enhance the communication potential of patients being treated for autism.
Design: A small series of patients (currently 7) with a diagnosis of autism are receiving galantamine augmentation. Three of the early recipients are described below in brief case reports.
Materials and Methods: Autism had been diagnosed using DSM-IV-TR Axis I clinical criteria. The patients were in good physical health but had reached a plateau in terms of cognition, function, and behavior relative to their individualized treatment plan goals. Each patient was given galantamine at bedtime in a 4-mg dose.
Results: Patient A is a 21-year-old black man living with a supportive family. His cognitive function was at a 2-year level. Although he seemed to follow simple commands, his “yes” and “no” responses were not always appropriate. His treatment regimen included asthma medications when needed, quetiapine fumarate, risperidone, and lorazepam as needed. In an attempt to abate stereotypes associated with autism and to stimulate appropriate communication, galantamine treatment (4 mg at bedtime) was added. Escalation of 4 mg to a current dose of 12 mg has produced modest improvements in speech and cognition.
Patient B is a 32-year-old black man living in a therapeutic community setting where he is cared for and supervised. He was given galantamine 4 mg daily at bedtime. Improvement was noted (eg, he began giving one- or two-word responses); however, galantamine was discontinued when a macular rash developed. Donepezil was initiated but was discontinued because, unlike with galantamine, behavioral and verbal regression ensued that subsided upon the drug’s discontinuation.
Patient C is a 42-year-old white man residing in a group home. He did not communicate and was generally chaotic and aggressive. He was given a 4-mg dose of galantamine at bedtime, and his aggressive behavior improved remarkably within 1 month. Drooling increased, but was manageable. Currently, he is undergoing dose escalation to a targeted dose of 16 mg at bedtime.
Conclusion: Treatment for autism involves special education, speech and language therapy, and psychopharmacologic intervention. In each of the cases described, galantamine had a positive effect on either verbalization, socially appropriate behavior, or both. Although these effects may be dose related, the results are less clear in this regard.
One patient developed a rash early on that reversed within days of discontinuation of galantamine. Another had increased, but tolerable, drooling. Substituting another anticholinesterase agent, donepezil, did not have the same positive effects. In fact, it worsened both verbalization and pro-social behavior.
The biochemical mechanism of the observed positive effects is uncertain. Although a possible indirect pathway to improved CNS serotonergic tone is conceivable, other possibilities exist. These preliminary results are encouraging, and an expansion of the patient treatment group is in progress.
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