Narcissus and Daffodil

342 D. Brown
cortex and hippocampus, results in reduced levels of acetylcholine which are
thought to be associated with loss of memory and disrupted cognition. Drugs that
preserve acetylcholine by inhibiting its destruction by cholinesterase, such as
neostigmine, rivastigmine, tacrine, metrifonate and galanthamine, can reduce
AD symptoms and delay, but not halt, disease progression (Mucke, 1997). Several
small trials and what amount to anecdotal reports provide an impression that
galanthamine is useful in this respect and, because of this early promise, several
larger and more carefully controlled trials are underway. This work is reviewed in
the next chapter of this volume. Specific, non-AD applications are described
below.
Neurological injury
Paskov (1986) reviews the use of galanthamine to treat a wide range of neurological
disorders. Most of the evidence is anecdotal and unclear, but it is logical to
expect that if the neurological injury involves a cholinergic pathway resulting in a
reversible deficit or imbalance of acetylcholine, then galanthamine may be of use.
Reversal of pathological paralysis
In the 1960s, galanthamine was used, again in eastern European countries, to
assist recovery from paralysis associated with poliomyelitis, neuromuscular disorders
or neuromuscular diseases. Trigeminal neuralgia was managed with oral and
intramuscular administration and occasionally by infiltration. Doses of 15–25 mg/
day were typically used (Kilimov, 1961a). Galanthamine was reported to produce
motor function improvement in 15 of 25 children with muscular dystrophy (Pernov
et al., 1961) and in patients with myasthenia and neuromuscular dystrophy (Pestel,
1961). Sixteen of 20 patients with brain injuries (not specified) showed improvement
on galanthamine (Kilimov, 1961b). Revelli and Grasso (1962) noted varying
degrees of benefit in 49 of 52 patients suffering from post-febrile polio during a
3-month trial of the drug at doses of 2.5–10 mg/day. Gopel and Bertram (1971)
reported the use of galanthamine in an heterogeneous group of patients studied
over a 30-month period, using subcutaneous doses of galanthamine in the range
1.25–25 mg daily. Beneficial effects were seen in the following disorders, some of
which were resistant to conventional therapy: facial paralysis (22 of 22); peripheral
neuropathy (38 of 46); paralysis of central origin (11 of 12); progressive myodystrophy
(1 of 2); poly/dermatomyositis (3 of 3) and multiple sclerosis (4 of 4). The
authors stated that the drug was well tolerated.
Gujral (1965) studied 100 patients with post-polio spinal paralysis, seven with
muscular dystrophy and two with facial paralysis due to lower motor neurones.
Galanthamine was administered as a series of courses of 40 subcutaneous injections,
repeated after a 6- to 8-week interval, up to a maximum of three courses per
patient. Total daily doses were related to age. Drug treatment was combined with
physiotherapy; this may have confounded the results, as physiotherapy was
already proven to be effective and was not administered uniformly. In any event,
the results were far from conclusive. Only modest number of patients showed
improvement with galanthamine. The author concluded that the drug was most
likely to have a beneficial effect in early cases of post-polio paralysis (improvement