CNS Stimulants: L-acetylcarnitine

A novel treatment for ADHD in FXS, the use of l-acetylcarnitine, was reported by Torrioli et al. (1999) in Italy, where stimulants are difficult to obtain. They treated 20 boys with FXS between the ages of 6 and 13 years with either 50 mg of l-acetylcarnitine or placebo twice a day and found a significant improvement in ADHD behavior by parent rating, but not by teacher rating, in those treated with l-acetylcarnitine. There was no change in IQ or in other neurocognitive testing. This medication is an acetyl derivative of carnitine, and in vitro it will inhibit the cytogenetic expression of the fragile site. This preliminary work deserves further study in a larger number of patients with FXS.

CNS Stimulants: Venlafaxine (Effexor) and Nefazodone (Serzone)

Alternative treatments for ADHD include the use of mixed noradrenergic-serotonin reuptake inhibitors such as venlafaxine (Effexor) and nefazodone (Serzone). These medications hold promise for treatment of ADHD in children and adolescents with FXS. Although controlled studies are not available, anecdotal experience suggests that venlafaxine is often helpful for ADHD in patients with FXS. Venlafaxine has been efficacious in child and adult studies for treatment of ADHD and for autism combined with ADHD (Olvera et al. 1996; Findling et al. 1996b; Findling and Dogin 1998; Hollander et al. 2000). As with most medication regimens described here, the combined use of these agents and psychotherapy, together, leads to improved outcome compared to medication alone (Keller et al. 2000).

CNS Stimulants: Amantadine (Symmetrel)

Other alternative treatments of ADHD in children with FXS include the use of amantadine. Amantadine (Symmetrel), an antiviral agent, is also a dopaminergic agent. It can be helpful for aggressive behavior and agitation in some individuals with developmental disabilities. Formal studies have been performed only on head-injured patients (Gualtieri et al. 1989) and in persons with hyperactivity and mental retardation, with a response rate of approximately 40% (Gualtieri 1990). Anecdotal reports and our experience suggest that amantadine can be helpful for the treatment of ADHD in children with FXS (Gualtieri 1992).

This article is not intended to give medical advice for individual cases.  Any change in medical treatment should be done in consultation with appropriate medical personnel. This article is written for medical professionals.  Some of the terms will be unfamiliar to those who are not trained in medical fields. *This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002.  It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in the book which are not included as part of this website. The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling 1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.

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