The effects of piracetam in children with dyslexia

Drug Improvement of Cognition : Hope and Reality

Recent research aimed at discovering and developing new drugs for diseases of cognition focuses heavily on Alzheimer’s disease and emphasizes mechanistic/biochemical approaches. Originally, research was based on a pragmatic search for compounds that would protect animals front disruptors of learning and memory. A series of compounds called nootropics do protect animals against these disruptions and offer hope that cognitive deficits may be amenable to pharmacological treatment. However, clinical development of these compounds is complicated by a number of factors. Among these is the poor correlation between animal models of cognitive loss and clinical disease states, a notable exception being the amnesic effects of benzodiazepines. Moreover, the inverted U-shaped dose-response function obtained in animal models and the lack of standard clinical outcome measures further complicate the development process. Tests that are beginning to gain acceptance as “standards” need to be characterized in terms of their validity, variability, and stability. There is a dearth of normative, especially longitudinal, data on cognitive decline. However, the great efforts being made in basic and applied research warrant cautious optimism.

The Diagnosis and Treatment of Reading and/or Spelling Disorders in Children and Adolescents

BACKGROUND

3-11% of children and adolescents suffer from a reading andor spelling disorder. Their poor written-language skills markedly impair their scholastic performance and are often associated with other mental disorders. A great deal of uncertainty still surrounds the question of the appropriate methods of diagnosis and treatment.

METHODS

We systematically searched for pertinent publications in databases and literature reference lists, summarized the evidence in six tables, and examined some of it in a meta-analysis. Recommendations were developed in a consensus conference.

RESULTS

A reading and/or spelling disorder should only be diagnosed if performance in these areas is below average. It should be determined whether an attention deficit-hyperactivity disorder, anxiety disorder, or disorder of arithmetical skills is also present. Reading and spelling performance should be reinforced with systematic instruction about letter-sound and sound-letter correspondences, letter-syllable-morpheme synthesis, and sound-syllablemorpheme analysis (g' = 0.32) (recommendation grade A). Spelling ability responds best to spelling-rule training (recommendation grade A). Irlen lenses, visual and/or auditory perceptual training, hemispheric stimulation, piracetam, and prism spectacles should not be used (recommendation grade A).

CONCLUSION

Evidence- and consensus-based guidelines for the diagnosis and treatment of reading and/or spelling disorders in children and adolescents are now available for the first time. Reading and spelling abilities should be systematically and comprehensively reinforced, and potential comorbid disorders should be sought and treated appropriately. The efficacy of many treatments now in use has not been documented; if they are to be used in the future, they must be tested in randomized, controlled trials. For adult sufferers, adequate diagnostic instruments and therapeutic methods are not yet available.

Effectiveness of treatment approaches for children and adolescents with reading disabilities: a meta-analysis of randomized controlled trials

Children and adolescents with reading disabilities experience a significant impairment in the acquisition of reading and spelling skills. Given the emotional and academic consequences for children with persistent reading disorders, evidence-based interventions are critically needed. The present meta-analysis extracts the results of all available randomized controlled trials. The aims were to determine the effectiveness of different treatment approaches and the impact of various factors on the efficacy of interventions. The literature search for published randomized-controlled trials comprised an electronic search in the databases ERIC, PsycINFO, PubMed, and Cochrane, and an examination of bibliographical references. To check for unpublished trials, we searched the websites clinicaltrials.com and ProQuest, and contacted experts in the field. Twenty-two randomized controlled trials with a total of 49 comparisons of experimental and control groups could be included. The comparisons evaluated five reading fluency trainings, three phonemic awareness instructions, three reading comprehension trainings, 29 phonics instructions, three auditory trainings, two medical treatments, and four interventions with coloured overlays or lenses. One trial evaluated the effectiveness of sunflower therapy and another investigated the effectiveness of motor exercises. The results revealed that phonics instruction is not only the most frequently investigated treatment approach, but also the only approach whose efficacy on reading and spelling performance in children and adolescents with reading disabilities is statistically confirmed. The mean effect sizes of the remaining treatment approaches did not reach statistical significance. The present meta-analysis demonstrates that severe reading and spelling difficulties can be ameliorated with appropriate treatment. In order to be better able to provide evidence-based interventions to children and adolescent with reading disabilities, research should intensify the application of blinded randomized controlled trials.

The co-occurrence of reading disorder and ADHD: epidemiology, treatment, psychosocial impact, and economic burden

The co-occurrence of reading disorder (RD) and attention-deficit/hyperactivity disorder (ADHD) has received increasing attention. This review summarizes the epidemiology, treatment strategies, psychosocial impact, and economic burden associated with the co-occurrence of these conditions. Common genetic and neuropsychological deficits may partially explain the high degree of overlap between RD and ADHD. Children who face the additive problems of both disorders are at greater risk for academic failure, psychosocial consequences, and poor long-term outcomes that persist into adulthood. However, few studies have evaluated interventions targeted to this patient population, underscoring the importance of identifying effective multimodal treatments that address the neuropsychological deficits of RD and ADHD through carefully planned clinical research.

Piracetam in severe breath holding spells

BACKGROUND

Breath holding spells (BHS) are apparently frightening events occurring in otherwise healthy children. Generally, no medical treatment is recommended and parental reassurance is believed to be enough, however, severe BHS can be very stressful for the parents and a pharmacological agent may be desired in some of these children.

OBJECTIVE

In this prospective study aim was to determine the usefulness of piracetam as prophylactic treatment for severe BHS.

METHODS

Children were recruited from Neurology Clinic in Children's Hospital, Islamabad between January 2002 to December 2004. Diagnosis of BHS was based on characteristic history and normal physical examination. Piracetam was prescribed to those children who were diagnosed as severe BHS in a dose ranging from 50-100 mg/kg/day. Iron supplements were added if hemoglobin was less than 10 gm%. Patients were seen at 2-4 weeks interval and follow-up was continued until 3 months after the cessation of drug therapy.

RESULTS

Fifty-two children were enrolled in the study, 34 boys and 18 girls. Ages ranged from 4 weeks to 5 years with mean age of 17 months. In 81% of children, spells disappeared completely and in 9% frequency was reduced to less than one per month and of much lesser intensity. Prophylaxis was given for 3-6 months (mean 5) duration.

CONCLUSIONS

Piracetam is an effective prophylactic treatment for severe BHS.

Piracetam: a review of pharmacological properties and clinical uses

Piracetam, a derivative of the neurotransmitter gamma-aminobutyric acid (GABA), has a variety of physiological effects that may result, at least in part, from the restoration of cell membrane fluidity. At a neuronal level, piracetam modulates neurotransmission in a range of transmitter systems (including cholinergic and glutamatergic), has neuroprotective and anticonvulsant properties, and improves neuroplasticity. At a vascular level, it appears to reduce erythrocyte adhesion to vascular endothelium, hinder vasospasm, and facilitate microcirculation. This diverse range of physiological effects is consistent with its use in a range of clinical indications. Its efficacy is documented in cognitive disorders and dementia, vertigo, cortical myoclonus, dyslexia, and sickle cell anemia. While high doses are sometimes necessary, piracetam is well tolerated.

Levetiracetam in autistic children: an open-label study

The objectives of this study were to determine whether autistic children taking levetiracetam (1) showed improvement in the areas of aggression, impulsivity, hyperkinesis, and mood instability, and (2) showed a nootropic response. Ten white autistic boys ranging from 4 to 10 years were compared pretreatment and while taking levetiracetam for an average of 4.1 weeks. Inattention, hyperkinesis, and impulsivity were evaluated using the Achenbach Attention Problems scale, Conners DSM-IV Total scale, and the Conners Attention-Deficit Hyperactivity Disorder Index scale, all of which showed statistically significant improvements. Mood instability was measured with the Conners Global Index (CGI) Emotional Lability and CGI Total scales, both of which showed statistically significant improvements. Aggressive behavior, as measured with the Achenbach Aggression scale, showed statistically significant improvement only for subjects who were not recently weaned from medications that reduce aggression (e.g., risperidone, carbamazepine, desipramine). Levetiracetam may reduce hyperactivity, impulsivity, mood instability, and aggression in autistic children with these problems. No nootropic effect was observed.

Controlled pilot study of piracetam for pediatric opsoclonus-myoclonus

Piracetam is an effective symptomatic treatment for some types of myoclonus in adults. To survey the efficacy and safety of piracetam in pediatric opsoclonus-myoclonus, we conducted an open, randomized, two-period, dose-ranging, double-blind, crossover, clinical trial of five children comparing the antimyoclonic properties of oral piracetam to placebo. We devised and validated a new rating scale, specifically for pediatric opsoclonus-myoclonus. Two parents while blinded were able to identify the active phase by improvement in behavior, but another thought the behavior was worse. None of the patients showed improvement in myoclonus. The adult-equivalent dose of piracetam used in this study, which is threefold higher than that used in previous pediatric studies, was well tolerated and safe. We found our rating scale to be a reliable and useful tool for future studies of opsoclonus-myoclonus in children.

Piracetam in developmental reading disorders: A review

This paper reviews the studies that have examined piracetam, the first of the nootropic drugs, as a treatment for developmental reading disorder. In various studies, 751 children have completed treatment in controlled double-blind trials using standardised tests of reading as outcome measures. Quantitative and qualitative review suggests that the findings are best interpreted as showing a statistical superiority of piracetam over placebo. Mechanism of action and clinical significance are discussed. The effect size is modest, but the drug is well tolerated and the balance of benefit over hazard is encouraging for future use.

Pediatric psychopharmacotherapy: a review of recent research

In the past 5 years, we have witnessed the continuation of important trends in clinical research that began earlier in the decade. With regard to the treatment of specific disorders in children and adolescents, the most significant developments have been the examination of the tricyclics for the treatment of depression and the initiation of controlled studies for the treatment of Tourette syndrome. Unfortunately, the findings from the depression studies have been uniformly negative, and the results of research on both depression and tic disorders show a relatively high rate of placebo responsivity, which raises nagging questions about the role of case reports and open trials. Another important trend in pediatric psychopharmacotherapy is the search for substitutes for the neuroleptics. Potential candidates include agents such as lithium, naltrexone, fenfluramine, clonidine, and carbamazepine. The most underresearched disorders are a combination of the least common (e.g. schizophrenia, mania) and those that are apparently perceived as less serious (e.g. sleep disorders, certain anxiety disorders). Not surprisingly, the most studied disorder and treatment is hyperactivity and stimulant medication, respectively. Considerable progress has been made in understanding the social implications of the associated symptoms and their response to stimulant drugs, aided greatly by the use of direct observation procedures. Researchers are beginning to attend to the implications of comorbidity for assessing response to medication. There has been additional confirmation of efficacy of stimulant treatment for preschoolers and adolescents. Dose-response issues remain to some extent unresolved, the primary impediments being interpretive misconceptions associated with trend analysis, an overreliance on the syndromal perspective and too little attention to target behaviors and their clinical implications, and the failure to operationalize the minimal effective dose with regard to the normalization and supranormalization of target and collateral behaviors. Disagreement over whether hyperactivity is a learning or a behavior disorder (or both) and what academic underproductivity means clinically and socially is also impeding progress. With regard to developmental disorders, controlled studies indicate that fenfluramine and naltrexone are effective for managing associated symptoms in some individuals. However, given the limited amount of research on these agents, their status as clinically useful palliatives must be considered tentative.(ABSTRACT TRUNCATED AT 400 WORDS)

The action of piracetam in ischaemic flaps

The effects of piracetam on skin flap viability, capillary blood flow and temperature were studied in abdominal cutaneous flaps in rats. The drug significantly increased the viability of the distal (random) portion of the flap and this response was dose-related. Compared with controls, the area of skin necrosis was 12.4% less in the piracetam-treated animals and extended necrosis was not observed. Piracetam appeared to act by increasing the capillary blood flow, mainly in the distal portion of the flap. The improved perfusion was reflected as a smaller drop in the recorded temperature compared with controls. Blood levels of this drug in animals receiving the maximum effective dose corresponded to the active drug concentration in human rheology.

Attentional capabilities of reading-impaired children during dichotic presentation of phonetic and complex nonphonetic sounds

Reading-impaired boys, who were deficient in nonverbal auditory processing skills, were tested on their ability to identify a single speech sound (CV) when presented in dichotic competition with a nontarget CV or complex nonspeech sound (bleat). Sixteen reading-impaired boys aged 9 to 14 and 16 age-matched controls were presented with 30 CV-CV pairs and 30 CV-Bleat pairs. No difference was found between the two groups in their ability to identify the target CV, regardless of whether the competing stimulus was phonetic or nonphonetic. It was concluded that reading-impaired children of the type studied here are characterized more by an attentional capacity limitation than by an inability to focus attention or by a specific inability to process phonetic information.

A brief review of studies of piracetam in dyslexia

Several double-blind studies of the effects of piracetam in developmental dyslexia are reviewed. There is general agreement among studies that piracetam appears to improve reading performance.

The effect of piracetam on short- and long-term verbal retrieval in dyslexic boys

Studies of 60 dyslexic boys age 8-14, carefully selected for exclusion of intellectual, sensory, psychiatric and neurological impairment and educational deprivation, were conducted to determine the efficacy of Piracetam, over a 12-week period, in improving reading and other related skills. There were no changes at the end of 12 weeks to distinguish the groups in accuracy or comprehension of prose-reading. Short-term memory gains, however, were recorded for the treated group on two different tests, digit span, and a test (Neimark) of immediate and delayed recall. The mean digit span scaled score for the entire group was one S.D. below their mean IQ. Considering only the performance of children whose digit span scaled scores were one S.D. or below the mean (7 or less), the treated group made a significant gain at the end of 12 weeks. On the Neimark test the treated group was significantly superior to the untreated group on first trial learning and they also lost significantly fewer object names after a delay. Improved retrieval from long-term storage could be demonstrated for the treated group on the rapid automatized naming test. Although there was no significant difference between the group at screening, the treated group was significantly faster on letter naming at the end of the drug trial. The treated group also improved their single word reading on the WRAT.

Effects of piracetam on developmental dyslexia

A new class of drugs (nootropics) are viewed from the perspective of their neuropsychological effect upon developmental dyslexia. Evidence from both the preclinical and clinical work conducted on Piracetam is briefly reviewed. The latest research on the effects of Piracetam in dyslexia shows a convergence of results. Attempts to replicate these results with dyslexia have only met with success in the areas of reading rate. In an attempt to find an independent replication of the Chase et al. (1984) finding, the author provides additional evidence on the effects of Piracetam on reading Rate X Accuracy in dyslexics.

The nootropic concept and dyslexia

A review is presented of controlled studies using intensive teaching intervention to improve dyslexics' reading ability. The results of eight controlled studies reveal only one showing the superiority of teaching. Taking this as a background, the work on Nootropics is reviewed. Both animal and clinical work with Piracetam (the first of the Nootropics) seems to indicate that this medication lacks significant or serious side effects and appears to promote memory and learning. Many double-blind studies of Piracetam have now been conducted on dyslexic children. These studies suggest that Piracetam improves the reading ability of dyslexics. In addition electrophysiological studies support the notion that Piracetam may be "left hemisphere active." Such encouraging trends will doubtless lead to further research in this interesting area.