043-056-Vlado Trajkovski-medicinski tretman - Journal of Special ...

MEDICINSKI TRETMANmedicinski tretmanNOVINI VO TERAPIJATA NAAUTIZMOTVladimir E. TRAJKOVSKIFilozofski fakultetInstitut za defektologijaRezimeU{te nema specifi~ni lekovi vo tretmanotna autizmot. Golem broj metodologiibile iskoristeni vo evaluacijata na bezbednostai efikasnosta na farmako -lo{kite tretmani kaj decata i vozrasniteso autizam. Vo studiite se osobeno zna~ajnidva parametra, a toa se postoewe "slepi# ikontrolni grupi. Studiite so najvisokkvalitet gi koristat dvete-"slepa# i kon -trolna procedura podednakvo. Tie treba dabidat izvedeni vo pove}e mesta i da sodr -`at golem broj subjekti.Istra`uvawata {to gi procenuvaat leko -vite, predlo`eni vo tretmanot na autizmot,postojano se vo porast. Zabele`livo e zabrzanoistaknuvawe na potrebata od testi -rawe na lekovite i podobra informacija zatretmanite, koja treba da bide pobrzo dostapnaotkolku vo minatoto. Vo ovoj trud }ebidat diskutirani slednite vidovi lekovii vidovi terapii: mo`ni idni tretmani solekovi-kako {to se oksitocin, tetrahidrobiopterini ampakinite, hormonska terapija,antigabi~na terapija, vitaminskite terapii,dimetilglicinot, alfa lipoi~natakiselina i terapiite so dieta.Klu~ni zborovi: autizam, terapija, studii.medical treatmentINOVATIONS IN THERAPY OF AUTISMVladimir E. TRAJKOVSKIFaculty of PhilosophyInstitute of Special Education and RehabilitationAbstractThere is no specifically marked medicine for thetreatment of autism. A number of approaches havebeen used in evaluating the safety and efficiency ofpharmacological treatments of both children andadults with autism. Two study parameters are particularlyimportant, the presence of “blind” andcontrol groups. The highest quality studies utilizeequally “blind” and control procedures as well.They have to be performed at multiple sites with alarge number of subjects.Research evaluating medicine proposed for treatmentof autism, is on the increase. There is acceleratedemphasis on medicine testing and betterinformation on treatments should be more availablethan in the past. In this article, the followingclasses of medicine and therapies will be discussed:possible future medicine treatments - suchas oxytocin, tetrahydrobiopterin and ampakines,hormone therapies, anti-yeast therapies, vitamintherapies, dimethylglycine, alpha lipoic acid anddiet therapies.Key words: autism, therapy, studies.Adresa za korespondencija:Vladimir E. TRAJKOVSKIUniverzit et "Sv. Kiril i Metodij#Filozofski fakultetInstitut za defektologijaBul. "Krste Misirkov# bb, 1000 Skopje, RMvladotra@fzf.ukim.edu.mkCorresponding Address:Vladimir E. TRAJKOVSKIUniversity "St. Cyril and Methodius"Faculty of PhilosophyInstitute of Special Education and RehabilitationBull. "Krste Misirkov" bb, 1000 Skopje, RMvladotra@fzf.ukim.edu.mkDEFEKTOLO[KA TEORIJA I PRAKTIKA 2004; 3-4: 43-5643

MEDICAL TREATMENTVovedAutizmot pretstavuva pervazivno razvojnonaru{uvawe {to se javuva vo ranoto detstvoi se karakterizira so naru{uvawa vo socijalnatai komunikatvnata sfera, namaleniinteresi i povtoruva~ko odnesuvawe (1).Autizmot bi trebalo da bide dijagnosti -ciran do vozrast od 18 meseci. Ranata in -tervencija e mnogu va`na za podobar ishod.Terapiite vklu~uvaat defektolo{ki tretman,logopedski tretman, okupaciska i bi -hejvioralna terapija. U{te nema specifi~nilekovi vo tretmanot na autizmot. Nemafarmakolo{ki tretman {to bi poka`almarkantno podobruvawe na jadrovite simptomikako {to se socijalnoto, govornoto ikognitivnoto naru{uvawe kaj autizmot.Medicinskite vidovi terapii ~esto imovozmo`uvaat na autisti~nite individui da`iveat nadvor od instituciite (2).Istra`uvawata {to gi procenuvaat lekovitei koi bile predlo`eni vo tretmanot naautizmot, postojano se vo porast. Zab ele` -livo e zabrzano istaknuvawe na potrebataod testirawe na lekovite i podobra informacijaza tretmanite {to treba da bidepobrzo dostapna otkolku vo minatoto.Celta na ovoj trud e da prika`e nekoi novividovi biomedicinski tretmani {to sekoristat vo svetot.1. Vidovi tretmani koi mo`eda se koristat vo idninaOksitocinot e mal peptiden hormon, sostavenod devet aminokiselini {to, normalno,se sekretira od majkata pri ra|aweto idoeweto na deteto. Vo animal nite studiibilo najdeno deka toj e aso ciran so socijalnotoodnesuvawe. Koga bil inektiran kaj`ivotnite, oksitocinot go zgolemil nivno -to socijalno odnesuvawe, a koga bile dadeninegovi blokatori, toga{ se namalilo nivnotosocijalno odnesuvawe i bila izbegnuvanasocijalnata interakcija (3).Podatocite kaj ~ovekot uka`uvaat na mo`nauloga na oksitocinot vo tretmanot na autisti~nitesimptomi.IntroductionThe autism is pervasive developmental impairmentthat occurs in early childhood characterized withimpairments in social and communicative sphere,reduced interests and repeated behavior (1).The autism has to be diagnosed up to the age of 18months. Early intervention is very important forbetter results. The therapies include special educationand rehabilitation treatment, treatment ofspeech therapist, occupational and behavioral therapy.There is no specifically marked medicine forthe treatment of autism. There are no pharmacologicaltreatments, which indicate noticeable im -provement of core symptoms such as social,speech and cognitive impairments of autism.Medical therapies often enable autistic individualsto live outside the institutions (2).Research evaluating medicine proposed for treatmentof autism, is on the increase. There is acceleratedemphasis on medicine testing and betterinformation on treatments should be more availablethan in the past.The aim of this article is to present some newtypes of biomedical treatments used in the world.1. Treatments that could be used in futureThe oxytocine is a tiny peptide hormone consistedof nine amino acids that mother normally secretsduring child’s birth and breast-feeding. The animalstudies associate it with social behavior. Whenoxytocine was injected in animals, it increasedtheir social behavior, and when its blockers wereused then their social behavior and social interactionwere reduced (3).Human data show that the role of oxytocine intreatment of autistic symptoms is possible.44JOURNAL OF SPECIAL EDUCATION AND REHABILITATION 2004; 3-4: 43-56

MEDICINSKI TRETMANVo edna studija bile ispituvani koncentraciitena oksitocin kaj 29 deca so autizam i30 izedna~eni po vozrast deca bez autizam.Decata so autizam imale poniski nivoa naoksitocin. Decata bez autizam poka`alepovisoki nivoa so tekot na vozrasta, {to nebilo slu~aj i kaj decata so autizam (4). Hollanderi sor. napravile dvojno-slepa, placebo-kontroliranastudija na infuzija so ok -sitocin kaj adulti, dijagnosticirani kakoautizam ili Asperger-ov sindrom. Tie zabele`alenamaluvawe na repetitivnoto odnesuvawekaj 13 od 15 nabquduvani subjektikoi primile infuzija so oksitocin. Za razlikaod niv samo 6 od 15 ~lenovi na placebo-grupatapoka`ale namaluvawe na repetitivnotoodnesuvawe. Ne bile najdeni razli -ki vo nesakanite efekti me|u oksitocin -skata i placebo-grupata. Ovie avtori uka-`ale i na toa deka socijalnoto odnesuvawemo`e da se podobri so oksitocinskiot tretman(5).Tetrahidrobiopterin (R-BH4) e drug lek,istra`uvan vo tretmanot na autizmot. Toj ehemisko soedinenie potrebno za sinteza nanevrotransmiterite, kako {to se serotoninoti drugite kateholamini. Vo edna otvo -rena pilot-studija {est predu~ili{ni decaso autizam bile tretirani so R-BH4. Rodi -telite soop{tile za podobruvawe vo kon -taktot so o~ite, vo `elbata za interakcijai vo brojot na zborovi. PET-skenovite po -ka`ale 10% zgolemuvawe vo vrzuvaweto nadopamin D2 receptorot vo n. caudatus i voputamen. N. caudatus i putamen se komponentina sistemot na bazalnite ganglii i se poliwadlaboko vo mozokot {to primaat razli~niimpulsi od korata na mozokot, giprocesiraat tie impulsi i gi vra}aat domotornata kora. N. caudatus vlijae na moti -vacionite procesi, a putamen e povrzan sonesvesnata koordinacija na ednostavnotosenzomotorno odnesuvawe. Bidej}i samoedna studija e sprovedena za ovoj lek, neop -hodni se i drugi istra`uvawa za da se proceninegovata bezbednost i efikasnost (6).One study examined the concentrations of oxytocinein 29 children with autism and 30 children atthe same age without autism. The children withautism had lower level of oxytocine. The childrenwithout autism showed higher level while growingup which was not the case in children with autism(4). Hollander et al. made double “blind”, placebocontrolledstudy of infusion with oxytocine inadults, diagnosed as autism or Asperger syndrome.They noted declined repeating behavior in 13 of 15observed subjects who received infusion withoxytocine. Contrary to them, only 6 of 15 membersof placebo group showed declined repeating behavior.There were no differences of unwantedeffects between oxytocine and placebo groups.These authors indicated that the social behaviorcould be improved with oxytocine treatment (5).Tetrahydrobiopterin (R -BH4) is another medicineexamined in the treatment of autism. It is achemical compound necessary for synthesis ofneuro-transmitters, such as serotonine and otherkateholamines. In one open pilot study, six preschoolchildren with autism were treated with R-BH4. The parents reported improvement in eyecontact, willing for interaction and number ofwords. PET -scans showed 10% increase in bindingof dopamine D2 receptor in n. caudatus and in putamen.N. caudatus and putamen are componentsof the basal ganglion system and they are areasdeep in the brain, which receive different impulsesfrom the brain cortex, process those impulses andreturn them back to the motor cortex. N. caudatusinfluences the motivating processes and putamen isconnected with unconscious coordination of sim -ple sense-motor behavior. Since there is only onestudy carried out on this medicine, other researchesare necessary to evaluate its safety and efficiency(6).DEFEKTOLO[KA TEORIJA I PRAKTIKA 2004; 3-4: 43-5645

MEDICAL TREATMENTAmpakini se relativno nova klasa lekovi{to ja poka~uvaat aktivnosta na AMPA-receptorot.Ovie receptori pomagaat vo prenesuvawena glutamatnite signali vo mo -zokot. Studiite poka`uvaat deka ovie zonivo mozokot se pomalku aktivni i imaat pomalagustina na AMPA-receptori. Tie lekovija podobrile memorijata kaj pacientiteso Alchajmerova bolest. CX516 e ampakin{to ima efekt vrz kognitivnite i bihejvioralnitesimptomi kaj individui soFragilen X sindrom i autizam (7).Ampakines are relatively new medicine class,which increase the activity of AMPA-receptor.These receptors help the transfer of glutamate signalsin the brain. The studies show that these areasin the brain are less active and with less density ofAMPA-receptors. They improved the memory ofpatients with Alzheimer disease. CX516 is am -pakine which influences cognitive and behavioralsymptoms in individuals with fragile X syndromeand autism (7).2. Hormonska terapija 2. Hormonal therapySekretinot e polipeptid, sostaven od 27aminokiselini, {to se sekretira vo tenkotocrevo kako odgovor na hlorovodorodnatakiselina od `eludnikot. Sekretinot se apsorbiravo krvta i go predizvikuva pan -kreasot da sekretira bikarbonati {to janeutraliziraat kiselinata vo crevoto.Sekretinot ja namaluva cirkulacijata vocrevoto i umereno go inhibira crevniotmotilitet, so {to go zabavuva dvi`ewetona crevnata sodr`ina. Poradi negoviteza{titni i smiruva~ki efekti na crevoto,sekretinot e koristen kako del od dijagnosti~kitestovi, sproveduvani za da gievaluiraat pri~inite na gastrointestinal -nite naru{uvawa; kako na primer, hro -ni~nata dijarea i sindromot na iritabilnicreva.Decata so autizam, kako i drugite deca {toimaat gastrointestinalni problemi, mo`eda primat sekretin pri dijagnosti~kototestirawe. Eden pacient so autizam, PeterBeck, na vozrast od ~etiri godini, primilsekretin pri laboratoriskoto testirawe,sprovedeno za da se vidat pri~inite za negovatahroni~na dijarea. Za tri nedeli davaweinfuzija so sekretin odnesuvawetomarkantno mu se promenilo. Peter mo`el daizre~e preku 100 zborovi, da ka`e kusire~enici, da odgovara na pra{awata i gopodobril kontaktot so o~ite. Negovata di -jarea, isto taka, se podobrila (8). Vo ednadruga studija se soop{teni sli~ni vidovipodobruvawa na simptomi, predizvikuvaj}iThe secretin is polypeptide, consisted of 27 aminoacids secreted in small intestine as a reaction to thechloro-hydrogen acids from the stomach. The secretinis absorbed in the blood and challenges thepancreas to secrete bicarbonates, which neutralizethe acid in the intestine. The secretin reduces thecirculation in the intestine and moderately inhibitsintestine motion, slowing down the movement ofintestine content. Because of its protective and relaxingeffects on the intestine, the secretin is usedas a part of diagnostic tests conducted to evaluatethe reasons for gastro-intestinal impairments; forexample: chronic diarrhea and syndrome of irritableintestines.Children with autism, as other children with gastro-intestinalproblems, can be treated with secretinwhile diagnostic testing. A patient with autism,Peter Beck, at the age of 4, was treated with secretinin laboratory testing carried out to find thereasons for his chronic diarrhea. After three-weektreatment of secretin infusion, the behavior remarkablychanged. Peter could pronounce morethan 100 words, compose short sentences, replyquestions and he improved eye contact. His diarrheaimproved, too (8). In another study, similarsymptom improvements are registered, causinginterest for secretin therapy in autism.46JOURNAL OF SPECIAL EDUCATION AND REHABILITATION 2004; 3-4: 43-56

MEDICINSKI TRETMANinteres za sekretinot kako mo`na terapijaza autizmot. Vo ovaa studija se uka`uva dekasekretinot mo`e da ja podobri sostojbataso crevnata li gavica, odnosno da ja normalizira,so {to se onevozmo`uva golemiteproteini, ili toksini da pominat od crevatavo krvta, so {to se prevenira sindromotna propu{tlivi creva (9). Koga se vnesuvavo terapevtski dozi, sekretinot se dava intravenski.Obi~no se dava vo pomali dozivo vremetraewe od {est nedeli, a vo golemadoza se dava edine~no. Dodeka vo nekoistudii nema izve{tai za nesakani efekti,nekoi drugi uka`uvaat deka e mo`no javuvawena osip po ko`ata, generaliziranocrvenilo na glavata, vratot i gradite vedna{po infuzijata, treska, tahikardija, po -vra}awe i zgolemena razdrazlivost. Ednood najnovite istra`uvawa gi otfrla nao -dite na onie studii kade {to sekretinot nepoka`al nikakov korisen efekt, ili imalnesakani dejstva. Ovaa dvojno-slepa, placebo-kontroliranai vkrstena studija poka-`uva deka sekretinot gi podobruva simpto -mite kaj decata so autizam {to imaathroni~na dijarea mnogu pove}e otkolku kajonie deca {to go nemaat ovoj problem. JanetKern i kolegite prou~uvale 19 deca soautizam davaj}i mu na sekoe dete ednainfuzija na sekretin (2CUs/kg) i edna infuzijana placebo solen rastvor. Istra`uva-~ite izvestile deka kaj 5 mom~iwa so hro -ni~na dijarea do{lo do namaluvawe na iri -tabilnosta, voznemirenosta, pla~eweto, hi -peraktivnosta, koga tie bile tretirani sosekretin, a nemale odgovor na placebo,dodeka drugite lica nemale odgovor ni nasekretin, ni na placebo. Kako dopolnuvawena ova, decata so autizam i hroni~na dijareapoka`ale podobruvawe vo re~nikot i namaluvawena stereotipnoto odnesuvawe.Pritoa bilo zabele`ano edno vlo{uvawekaj edno dete bez gastrointestinalni simptomi,kaj kogo do{lo do eskalirawe nabihejvioralnite problemi. Na krajot, tiezaklu~uvaat deka mo`ebi ima subtip nadeca so autizam ili pervazivno razvojnonaru{uvawe i hroni~na dijarea koi imaatpolza od sekretinot (10).This study shows that secretin can improve thecondition of intestinal mucus, i.e. normalize it disablingthe big proteins or toxins to pass from intestinesinto the blood, which prevents the syndromeof porous intestines (9). When inserted intherapeutic doses, the secretin is applied intravenously.It is usually applied in smaller doses induration of six weeks, or once if it is a bigger dose.Some studies show no side effects while othersreport possible occurrence of skin rash, generalizedblush on head, neck and chest immediatelyafter the infusion, as well as fever, tachycardia,vomiting and increased irritability. One of the latestresearches rejects the findings of the studieswhere secretin did not show any useful effect norhad unwanted activities. This double “blind”, placebocontrolled and cross-examined study showsthat secretin improves symptoms in children withautism and chronic diarrhea much better than inthose children without this problem. Janet Kernand colleagues studied 19 children with autism,giving each child an infusion with secretin(2CUs/kg) and one infusion of placebo salty solution.The researchers reported that 5 boys withchronic diarrhea reduced the irritability, anxiety,crying, hyperactivity when treated with secretin,and did not respond to placebo, while others didneither respond to secretin nor placebo. Additionallyto this, children with autism and chronic diarrheashowed improvement in vocabulary and reductionof stereotype behavior. The aggravationwas noticed in one child without gastrointestinalsymptoms who showed escalation of behavioralproblems. At the end, they concluded that therewas a subtype of children with autism or pervasivedevelopmental impairment and chronic diarrhea,who benefited the secretin (10).DEFEKTOLO[KA TEORIJA I PRAKTIKA 2004; 3-4: 43-5647

MEDICAL TREATMENT3. Antigabi~na i fungicidna terapija 3. Anti-yeast and Fungicide TherapyProbioticite se mikroorganizmi {to se Probiotic is a microorganism used in therapeutickoristat vo terapevtski celi za da go kon -troliraat razmno`uvaweto na gabite, fun -aims to control growth of yeast, fungi and intestinalbacteria. There are hundreds of differ ent usefulgite i bakteriite vo crevata. Ima stoticirazli~ni vidovi polezni bakterii koi se types of bacteria available in pharmaceuticaldostapni vo farmacevtskite ku}i, a nekoihouses, such as: Lactobacillus acidophilus, Lactobacilluscasei, Lactobacillus bulgaricus, Lactoba-od niv se: Lactobacillus acidophilus, Lactobacilluscasei, Lactobacillus bulgaricus, Lactobacillussalivarius, Lactobacillus termophilus i Lactobacillusplantarum. Drugi polezni vidovi gi Lactobacillus plantarum. Other useful types arecillus salivarius, Lactobacillus termophilus andvklu~uvaat: Bifidobacterium bifidum i Streptoc - Bifidobacterium bifidum and Streptoccus faeciumcus faecium (da ne se pome{a so Streptoccusfaecalis, koj e patogena bakterija). Ovie vi -(not to be confused with Streptoccus faecalis,dovi bakterii mo`e da se najdat vo razli~ - which is pathogen bacteria). These types of bacteriacan be found in different forms, such as suspen-ni formi, kako {to se suspenzii, pra{oci,kapsuli i tableti. Ovie produkti mo`e dasions, powders, capsules and pills. These productspomognat vo kontrola na gabite i patogenitebakterii od rodot Clostridia vo crevniot can help to control yeasts and pathogenic bacteriatrakt. Se prepora~uva simultana upotreba from the family Clostridia in intestinal tract. Simultaneoususe of Probiotic with fungicide therapyna probioticite so fungicidna terapija.Gabite se del od crevniot ekosistem i tieis recommended. The fungi are part of intestinalgi dr`at drugite organizmi pod kontrola.Dokolku ne se zemaat probiotici simul - eco system and they control other organisms. Iftano so fungicidni lekovi, toga{ mo`e da Probiotic is not simultaneously used with fungicidese slu~i da dojde do razmno`uvawe na pato - medicine, then a growth of pathogenic bacteria cangenite bakterii.occur.Druga va`na postapka e kontrola na razmno`uvawetona gabite preku dieta, odnosnoisfrlawe na {e}erite, poradi niv-bacteria growth through diet, i.e. ejecting of sugarAnother important procedure is the control ofniot pottiknuva~ki efekt na razmno`uvawetona gabite. Osnovno pravilo vo elimi -because of its stimulating effect on bacterianacijata na {e}erite e: toa {to e slatko, dagrowth. The basic rule for sugar elimination is notne se jade. Listata na ograni~eni hrani to eat sweets. The list of restricted food includesvklu~uva: bonboni, sladoled, torti, blagi candies, ice cream, cakes, sweet pies, chocolate,piti, ~okolada i ovo{ni sokovi. Otkakoand fruit juices. When starting with this diet, itdeteto }e po~ne so ovaa dieta se ~ini dekavodata }e mu stane glaven pijalak. Site vi - seems that water becomes the main drink for thedovi {e}er treba da bidat eliminirani, child. All types of sugar should be eliminated includinghoney, syrups, fruit sugar and refinedvklu~uvaj}i go i medot, i sirupi te, iovo{niot {e}er i rafiniranite {e}eri.Nekoi avtori prepora~uvaat kompletnasugar. Some authors recommend complete whileeliminacija, dodeka drugi prepora~uvaat others recommend temporary elimination. Sometimes,however, it is necessary to add vitamin C ifpovremena. Ponekoga{, mo`ebi, }e bidepotrebno dodavawe vitamin-C ako deteto ethe child is used to drinking orange juice, which isnaviknato da pie sok od portokal koj, istotaka, e eliminiran. Ovo{jeto mora da bidealso eliminated. The fruit must be eliminated fromotstraneto od ishranata za eden mesec za da the diet in a period of one month in order to fastense zabrza eliminacijata na gabite.the elimination of fungi.48JOURNAL OF SPECIAL EDUCATION AND REHABILITATION 2004; 3-4: 43-56

MEDICINSKI TRETMANDesertite {to sodr`at mnogu {e}er trebada bidat isfrleni na neopredeleno vreme.Vo toj slu~aj glavni izvori na jaglenohidrati}e bidat kompirite, gravot, p~enkata,sladok tropski kompir, brokola i dr. Sitevidovi meso i riba se dozvoleni vo ishranata.Dietata, isto taka, treba da bide kombiniranaso fungicidna terapija, {to davadvapati pogolem efekt vo eliminacijata narazmno`enite crevni gabi, otkolku ako di -etata se koristi bez fungicidnata terapija.Nistatin e eden od najstarite i najbezbednifungicidni lekovi. Negovata bezbednost sedol`i na faktot {to toj ne se apsorbira vokrvotekot vo dozi koi naj~esto se pripi{uvaat.Re~isi 100% od nistatinot se elimi -niraat vo fecesot. Zaradi toa {to ne vleguvavo krvta, toj e bezbeden i ne mo`e dapredizvika nekoi seriozni nesakani dejstva.Mnogu od decata so autizam ne sakaatda zemat kapsuli, zaradi {to najdobra op -cija e davawe vo forma na suspenzija.Naj~esto suspenziite na nistatin se for -mulirani da sodr`at 100.000 edinici vo1ml. Ako se dade vo 4-8 pati pogolemi doziod prepora~anite, toga{ mo`e da dade nesakaniefekti vo smisla na zgolemena agresivnost.Amfotericin B mo`e da bide mnogutoksi~en ako se dade intravenski. Zatoa,pak, daden oralno toj e mo{ne bezbeden lek.Koga }e se dade oralno, negovata bezbednostse sporeduva so onaa na nistatinot, bidej}itoj lo{o se apsorbira od GIT (11).The deserts, which consist of much sugar, shouldbe eliminated forever. In that case, main sources ofcarbohydrates are potatoes, beans, corn, sweet potatoes,broccoli and others. All kinds of meat andfish are allowed in the diet. The diet should bicombined with fungicide therapy, which showstwice bigger effect in elimination of intestinalfungi growth, than if the diet is used without it.Nystatin is one of the oldest and the safest fungicidemedicine. It is safe due to the fact, that it isnot absorbed in the circulation of the blood inmostly prescribed doses. Almost 100% of Nystatineis eliminated in feces. Because it does notenter the blood, it is safe and cannot cause any seriousand unwanted activities. Many autistic childrendo not want to take capsules and the best optionis a suspension. Most frequently, suspensionof Nystatin is formulated to contain 100.000 unitsin 1 ml. If it is applied in 4 - 8 times bigger dosesthan the prescribed one, then it can show unwantedeffects of increased aggressiveness.Amphotericin B can be very toxic if applied intravenously.If applied orally, it is a very safemedicine. When applied orally, its safety is com -pared to the one of Nystatin because it is badlyabsorbed from GIT (11).4. Vitaminoterapija 4. Vitamin TherapyVo 18 studii, sprovedeni za evaluacija nadejstvoto na vitaminot B6 kaj licata so autizam,toj poka`al pozitivni rezultati.Nitu eden nesakan efekt ne bil soop{tenvo tie studii. Ova e pove}e od zna~aenrezultat za efikasnosta i bezbednosta, oso -beno ako se znae deka drugite lekovi {to sedavaat kaj autizmot poka`ale nekonzistentnirezultati i imale rizik od nesakaniefekti.In 18 studies implemented for evaluation of influenceof vitamin B6 on people with autism, itshowed positive results. There were no unwantedeffects, reported in these studies. It has been morethan a significant result for the efficiency andsafety, especially when it is known that othermedicine applied in autism showed inconsistentresults and had unwanted effects.DEFEKTOLO[KA TEORIJA I PRAKTIKA 2004; 3-4: 43-5649

MEDICAL TREATMENTIstra`uvawata za upotrebata na vitaminotB6 po~nale vo 60-tite godini od minatiotvek. Vo 1966 godina dvajca britanski nevrolozi- A.F. Heeley i G.E. Roberts – soop{tiledeka kaj 11 od 19 deca so autizam na{leabnormalni metaboliti vo urinata priupotrebata na triptofanski test. Davaj}iim po 30 mg tableta vitamin-B6 do{lo donormalizirawe na nivnata urina. Vo taastudija ne bile napraveni bihejvioralni ispituvawa.Germanskiot istra`uva~ V.E.Bonisch vo 1968 godina izvestil deka kaj 12od 16 deca so autizam imalo zna~itelnopodobruvawe vo povedenieto koga im bilodadeno visoki dozi vitamin-B6 od 100 mg do600 mg dnevno. Trojca od negovite pacientiprvpat prozborele po davaweto na vitami -not-B6 vo ovoj otvoren klini~ki obid.Po izdavaweto na knigata "Infantilen autizam#od d-r Bernard Rimland vo 1964 godina,toj po~nal da prima stotici pisma od ro -ditelite koi se obidele so megavitaminskaterapija kaj nivnite deca so autizam. Vopra{alnikot, {to toj im go pratil na oko -lu 1000 roditeli, otkril deka 57 eksperi -mentirale so visoki dozi na vitamini.Mnozina od niv videle pozitivni rezultatikaj nivnite deca. Kako rezultat na toa, Rimlandpo~nal golema studija so preku 200 decaso autizam na koi im dal megadozi na vitamin-B6, nijacinamid, pantotenska kiselinai vitamin-C. Vitaminite bile smes teni voedna multipna tableta, specijalno dizajniranaza ovaa studija. Na krajot od studijata,po ~etiri meseci, bilo jasno deka vitaminotB6 bil najva`niot od site 4 ispituvanivitamini i deka vo nekoi slu~i dovel doizvonredno podobruvawe. Vitaminot-B6 po -ka`al zna~itelno podobruvawe kaj 30% do40% od decata. Samo nekolku od decatapoka`ale minorni nesakani efekti (razdrazlivosti ~uvstvitelnost na zvukovi), notie is~eznale koga bil dodaden magnezium.Magneziumot ne samo {to gi eliminira nesakaniteefekti, tuku toj ~esto go podobruvagovorot i povedenieto. Dve godini po -docna toj i drugi dvajca istra`uva~i iniciralevtora ekperimentna studija za mega vitaminskataterapija, koncentriraj}i se navitamin -B6 i magnezium.50The research on the use of vitamin B6 started inthe 60s of the last century. In 1966, two Britishneurologists – A.F. Heeley and G.E.Robers – reportedthat 11 of 19 children with autism foundabnormal metabolites in the urine using triptophantest. Applying each patient 30 mg tablet of vitaminB6 they succeeded in normalizing the urine. Thisstudy did not make any behavioral investigations.The German researcher V.E.Bonisch in 1968 reportedthat in 12 of 16 children with autismshowed significant behavioral improvement whenthey were applied high doses of vitamin B6 from100 mg to 600 mg per day. Three of his patientscould talk for the first time after applying vitaminB6 in this open clinical trial.After the publication of the book “Infantile autism”,Dr. Bernard Rimland in 1964 started receivinghundreds of letters by parents who hadtried megavitamin therapy on their children withautism. In the questionnaire he had sent to about1000 parents, he found out that 57 had experimentedwith high doses of vitamins. Most of themsaw positive resultants with their children. As aresult of this, Dr. Rimland started a large studywith over 200 children with autism who weregiven mega doses of vitamin B6, niacynamid,pantoten acid and vitamin C. The vitamins wereput in a multi type tablet, specially designed forthis study. At the end of the study, after fourmonths, it was obvious that the vitamin B6 was themost important one of the four examined vitaminsand that in some cases it brought excellent im -provements. The vitamin B showed considerableimprovement with 30% to 40% of the children.Only a few children showed minor unwanted effects(irritable and sensitive to sounds) which disappearedwhen magnes ium was added. Magnesium,not only eliminates unwanted effects, but itfrequently improves speech and behavior.Two years later, he and two other researchers initiateda second experimental study for megavitamintherapy, concentrating on vitamin B6 and magnesium.JOURNAL OF SPECIAL EDUCATION AND REHABILITATION 2004; 3-4: 43-56

MEDICINSKI TRETMANToj bil dvojno -slep placebo-kontroliraneksperiment kaj 16 deca so autizam i povtornoimalo statisti~ki zna~ajni rezul -tati. Dozite se dvi`ele me|u 300 mg i 500 mgdnevno.Vo dvete studii decata poka`ale {irokrang na izvonredni rezultati so vitamin -B6. Tie imale podobar kontakt so o~ite, po -ka`uvale pogolem interes kon svetot okoluniv, pomalku bile besni, govorot bil po -dobar i, op{to zemeno stanale ponormalni.Francuskite istra`uva~i, predvodeni odprof. Gilbert LeLord, napravile dopolnitelnoistra`uvawe so vitamin -B6 i magnezium.Nivniot eksperiment go sprovele vrz 44hospitalizirani deca so autizam. Ottoga{imaat publicirano pove}e studii, kade {toja ispituvaat upotrebata na vitamin-B6 somagnezium ili bez nego kaj deca i adulti soautizam. Vo nivnite studii davan e 1 gramdnevno vitamin -B6 i polovina gram magnezium.LeLord i sor. neodamna gi rezimiralerezultatite od 91 pacient, kade {to zabele`ale:kaj 14% markantno podobruvawe,kaj 33% podobruvawe, 42% bile bez podo -bruvawe i kaj 11% vlo{uvawe na klini~ -kata slika. Vo site nivni studii ne bilezabele`ani nesakani dejstva.Drugi dve studii od istra`uva~kite grupivo SAD, predvodeni od Thomas Gualtieri isor. na Univerzitetot vo Severna Karolinai George Ellman i sor. od So noma, dr`avnatabolnica vo Kalifornija, imale pozitivnirezultati kaj pacientite so autizam (12).Vitaminot C e va`en antioksidant i mo`eda bide od golema polza kaj decata so au tizam.Toj e vitamin rastvorliv vo voda i zatoamnogu retko mo`e da se zabele`ivistinska toksi~nost, osven {to mo`e da seformiraat kristali na askorbinskata kiselinavo urinata, koga toj se koristi vo ekstremnovisoki dozi. Vitaminot-C treba dapo~ne da se dava vo doza od 5-10 mg/kg/dnevnoso postepeno poka~uvawe na dozata. Avto -rite postavile hipoteza deka dejstvoto sedol`i na pretpostavenite dopaminergi~kiefekti na vitaminot-C. Kako i da e, rezul -tatite od ovaa studija u{te ne se povtoreni(13).DEFEKTOLO[KA TEORIJA I PRAKTIKA 2004; 3-4: 43-56That was a double “blind”, placebo-controlled experimentwith 16 children with autism and againthere were statistically significant results. Thedoses ranged from 300 mg to 500 mg per day.In both studies, the children showed wide range ofexcellent results with vitamin B6. They had bettereye contact, showed bigger interest for the worldaround them, were less furious, their speech wasimproved, they became more normal in general.The French researchers led by Professor GilbertLeLord additionally examined vitamin B6 andmagnesium. Their experiment was carried out with44 hospitalized children with autism. Since then,they have published a large number of studies, examiningthe use of vitamin B6 with magnesium orwithout it, both with children and adults. In theirstudies, a daily dose of 1 g. vitamin B6 and half agram magnesium was applied. Lelord and associateshave summarized their results recently with 91patients and stated 14% with noticeable improvement,33% with improvement, 42% without im -provement and 11% with worse clinical picture. Inall their studies, unwanted actions have not beennoticed.Other two studies of the research groups fromUSA, led by Thomas Gualtieri and associates atthe University of North Caroline and George Ellmanwith associates from Sonoma, the state hospitalin California, has pos itive results in patientswith autism (12).Vitamin C is an important antioxidant and couldbe of great benefit for children with autism. Thevitamin is soluble in water and therefore real toxicityis rarely noticeable, except formation ofcrystals in ascorbine acid in the urine when used inextremely high doses. Vitamin C has to be appliedwith starting daily dose of 5/10 mg/kg and withgradual increase of the dose. The use of vitamin Chas been examined in a small double “blind”, placebo-controlledcross-examined study, where aslight alleviation of the symptoms has been foundin schoolchildren with autism. The authors haveput forward hypothesis that the action is due toassumed dopaminergic effects of vitamin C. Theresults of this study have not been repeated again(13).51

MEDICAL TREATMENTFolnata kiselina e polezna za upotreba kajautizmot. Golemiot francuski istra`uva~Jerome Lejeune izvestil deka davawe naokolu 250 mikrogrami folna kiselina nakilogram telesna te`ina dnevno doveduvado golemi podobruvawa kaj nekoi deca soautizam. Toj daval folna kiselina na il -jadnici mentalno retardirani deca (naj-~esto so Down-ov sindrom) po 20 mg dnevnovo razli~ni studii, bez da ima nikakvi{tetni i nesakani efekti (14).Folic acid is useful when applied for autism. Thegreat French researcher Jerome Lejeune reportedthat a dose of 250 mg of folic acid at one kilogramof corporal weight per day showed great improvementsin some children with autism. He applied adaily dose of 20 mg folic acid to thousands ofmentally retarded children (mostly with Downsyndrome) in different studies without any harmfuland unwanted effects (14).5. Dimetilglicin (DMG) 5. Dimethyl-glycine (DMG)Dimetilglicinot e supstancija so sladokvkus, opi{ana kako prirodna, ednostavnasostojka so nepoznati, nepo`elni i nesakaniefekti. DMG e dostapen vo mnogu pro -davnici za zdrava hrana vo SAD. Toj legalnoe klasificiran kako hranliva supstancija.Se upotrebuva vo pove}e formi, anaj~esto kako sitni tableti od 125 mg. Vkusotmu e prijaten i decata brzo gi xvakaattabletite.Mnogu studii imaat doka`ano deka DMG jazasiluva efikasnosta na imuniot sistem, gipodobruva fizi~kite i atletskite perfor -mansi kaj lu|eto i `ivotnite i ima {irokrang na polezni efekti. Toj e mnogu bezbeden.Mo`e da se sretne vo mnogu mali koli-~estva vo kafeaviot oriz i crniot drob.Hemiski i fiziolo{ki toj prilega na vi -taminite rastvorlivi vo voda, kako naprimer, vitaminite od B-grupata. Glavnatapri~ina {to toj ne e klasificiran kakovitamin e toa deka nema specifi~ni simp -tomi povrzani so deficit na DMG.Mnozina roditeli izvestile deka u{te voprvite denovi od po~etokot na terapijataso DMG, povedenieto na decata za bele`itelnose podobrilo−bil zabele`an podobarkontakt so o~ite, govorot bil podobren idecata poka`uvale pogolem interes i mo`nostza zboruvawe.Za predu~ili{ni deca se prepora~uva zapo~etok polovina od 125 mg tableta ilikapsula zaedno so pojadokot, a za pogolemideca po edna tableta.DMG is a substance with sweet taste described asnatural, a simple component with unknown andunwanted effects. DMG is available in manyhealthy food stores in USA. It is legally classifiedas nutritious substance. It is used in many formsmostly as small tablets of 125 mg. They are tastefuland children quickly chew them.Many studies have proved that DMG enhancesefficiency of the immunity system, improvesphysical and athletic performances, both in peoplein animals, and has a wide range of useful effects.It is very safe. It is present in small quantities inbrown rice and the liver. From the aspect ofchemistry and physiology, it is soluble in waterlike vitamins, as for example vitamins of B group.The main reason it has not been classified as vitaminis the fact that it has not specific symptomsrelated to the deficit of DMG.Since the very beginning of the therapy withDMG, many parents reported that their children’sbehavior considerably improved, they had bettereye contact, improved speech, showing greaterinterest and abilities for talking.At the beginning, pre-school children are recom -mended a daily dose of half of 125 mg tablet orcapsule when having breakfast, and older childrenone tablet.52JOURNAL OF SPECIAL EDUCATION AND REHABILITATION 2004; 3-4: 43-56

MEDICINSKI TRETMANPostepeno treba da se zgolemuva dozata odedna na ~etiri tableti dnevno, a za vozrasniteod 2 na 8 tab leti dnevno. Ako se pojavipo~etno zgolemuvawe na hiperaktivnosta({to se javuva kaj 5-10% od slu~aite), toga{dozata treba da se namali. Vo toj slu~aj, sedodava 800 mikrogrami folna kiselina. Seprepora~uva davawe na DMG 2-3 nedeli, po -toa dodavawe na B6 i magnezium {to, istotaka, treba da po~ne postepeno (12).The dose has to be continuously increased from 1to 4 tablets daily, and for adults 2 to 8 tablets perday. The dose has to be reduced if initial increaseof hyperactivity occurs (noticed at 5 – 10% ofcases). In that case, 800 mg folic acid is added.DMG is recommended to be applied for 2-3weeks, then gradually adding B6 and magnesium(12).6. Alfa-lipoi~na kiselina 6. Alpha -Lipoic AcidAlfa-lipoi~nata kiselina e ditiol masnakiselina, koja pretstavuva priroden vrzuva~kiagens i mo}en antioksidans. Taa bilaupotrebuvana vo Germanija pri tretmanotna dijabeti~na nevropatija so odli~ni rezultati.Nejzinite antioksidantni efektimo`e osobeno da bidat od pomo{ kaj decataso autizam. Se po~nuva so doza od 1-3mg/kg/dnevno i se poka~uva do 10 mg/kg/dnevno.Alfa-lipoi~nata kiselina e prirodenprodukt na ~ove~kite kletki i zaradi toaima minimalna toksi~nost. Ispituvanitedozi nad 25 mg/kg/dnevno, davani pove}e od 3godini kaj vozrasni lica, ne poka`aletoksi~nost. Alfa-lipoi~nata kiselina mo -`e da go olesni otstranuvaweto na `ivataod intracelularno do ekstracelularno. Toamo`e da bide mnogu polezno za mobilizirawetona `ivata {to ovozmo`uva dostapnostna DMSA da ja vrze `ivata (15).Alpha-lipoic acid is ditiol fatty acid, which is anatural binding agent and powerful antioxidant. Itwas used in Germany on the treatment of diabeticneuropathy with excellent results. Its antioxidanteffects can be a great benefit in children with autism.The treatment starts with a daily dose of 1-3mg/kg and it increases to 10 mg/kg. Alpha-lipoicacid is a natural product of human cells and thereforeit has minimal toxicity. The examined dosesof more than 25 mg/kg daily applied for more than3 years with adults, did not show any toxicity. Alpha-lipoicacid can alleviate the removal of mercuryfrom intracellular to extra-cellular. That canbe very useful for mobilization of mercury, whichenables DMSA to bind mercury (15).7. Dieta slobodna od gluten i kazein 7. Diet Free of Gluten and CaseinGlutenite se proteini {to se sre}avaat vorastitelniot svet i pripa|aat na potklasatamonokotiledoni. Vo ova semejstvo sep~enicata, ja~menot, ovesot, ‘r`ta i nivnitederivati. Kazeinot e fosfoprotein odmlekoto, ~ija molekularna struktura e mno -gu sli~na so onaa na glutenot.Ima sigurni podatoci deka nekoi od lu|etoso autizam se intolerantni kon hrana {tosodr`i gluten i kazein, pri {to reagiraatso mnogu fizikalni i bihejvioralni prob -lemi, kako {to se: glavobolka, bolka vo`eludnikot, gadewe, vriskawe i pla~ewe,Glutens are proteins present in flora and belong tothe subclass monocotyledons. In this family arewheat, barley, oats, rye and their derivates. Caseinis phosphor protein in milk with very similarmolecule structure to gluten.There are certain data that some people with autismare intolerant towards food that contains glutenand casein and they respond with many physicaland behavioral problems such as headaches,stomachaches, nauseating, screaming and crying,sleeping problems, hyperactivity, aggression, highDEFEKTOLO[KA TEORIJA I PRAKTIKA 2004; 3-4: 43-5653

MEDICAL TREATMENTproblemi vo spieweto, hiperaktivnost, agresija,pre~uvstvitelnost kon zvukovi, zamor,depresija, crevni problemi (dijareja,opstipacija, gasovi), u{ni infekcii duri ikonvulzii. Za da se podobri ovaa simptomatologijatreba da se izbegnuvaat onie vi -dovi hrana {to gi sodr`at glutenot i kazeinot.Tretmanot so dieta bez gluten i kazein po -drazbira pridr`uvawe kon odredeni pravila{to treba da se po~ituvaat:• dietata mora da se sproveduva kontinui -rano i dosledno;• nau~ete go deteto deka hranata ne e samozadovolstvo, tuku i izvor na zdravje;• odnapred bidete gotovni na isku{enijai imajte dobra zamena za sekoj vid hrana;• odnapred obezbedite dobra i vkusnahrana za deteto;• zdravjeto na deteto neka bide prioriteti celoto semejstvo neka ja zema istata hranakako i deteto;• povrzete se so drugi lu|e {to primenuvaatvakva dieta;• vnimavajte na saboterite vo ishranata;• poka`ete í na sredinata deka sakate nadeteto da mu pomognete, a nikako dekasakate da mu go smenite na~inot na `ivot;• ispituvajte go toa {to treba da vleze vodetskiot organizam, vklu~uvaj}i gi lekovite,vitaminite i drugo;• sadovite za gotvewe na hranata i priborotza jadewe mora da bidat posebni;• produktite koi se upotrebuvaat mora dabidat posebno skladirani;• da se izvestat rodninite za celite nadietata i da se zamolat da ne im davaat nadecata tajno od zabranetata hrana;• nikako ne predavajte se bidej}i nakrajot }e bidete zadovolni od rezultatite.Prehranbeni produkti {to mo`e da sekoristat vo dietata bez gluten i kazein seslednive:54sensitivity to sounds, fatigue, depression, in testinalproblems (diarrhea), obstipatio, gases), earinfections and other convulsions. Food containinggluten and casein should be avoided in order toimprove these symptoms.The treatment with a diet free of gluten and caseinmeans obeying certain rules that have to be respected:• The diet has to be carried out continuously andpersistently;• Teach your child that food is not only pleasure,but source of health;• Be ready for temptations in advance and havegood replacement for any kind of food;• Provide, in advance, good and tasty food foryour child;• The health of your child has to be a priorityand the whole family has to use the same food asyour child;• Contact with other people who use the samediet;• Take care of nutrition saboteurs;• Show people that you want to help your childand not to change the child’s life;• Examine everything which enters your child’sorganism, including medicine, vitamins and so on;• The dishes for preparing food and cutlery haveto be special;• The used products have to be separately stored;• To inform the relatives about the aims of thediet and to ask them not to give the child secretlythe forbidde n food;• Do not give up because, at the end you will besatisfied with the results.Food products that can be used in the diet free ofgluten and casein are the following:JOURNAL OF SPECIAL EDUCATION AND REHABILITATION 2004; 3-4: 43-56

MEDICINSKI TRETMAN• Izvori na proteini : svinsko meso,jagne{ko meso, tele{ko meso, june{ko meso,pile{ko meso, meso od misirka, patka,fazan, rakovi, {kolki, tuna, pastrmka,losos, sardini, jajca, rastitelni proteini -soja, lu{pi od soja, jogurt od soja.• Bra{na: orizovo bra{no, soino bra{no,skrob od p~enka, p~enkarno bra{no, griz,bra{no od le}a, bra{no od grav, bra{no odkosteni, bra{no od proso.• Zelen~uk: zelena salata, praz, luk, mor -kov, celer, magdonos, bel kompir, domati,spana}, cveklo, zelena piperka, gra{ok, bo -ranija, soja, grav, krastavica, tikva, tik -vici, zelka, karfiol, p~enka, trupka.• Ovo{je: kru{ki, duwi, smokvi, portokali,mandarini, jagodi, malinki, kapinki,ananas, diwa, lubenica, kokos, urmi, boro -vinki, kajsii, praski, slivi, suvi slivi,cre{ni.• Pijalaci : ovo{ni sokovi, sok od mor -kov, sok od cveklo, sok od domati.• Zrnesti i semkasti produkti : orevi,son~ogledovi semki, semki od tikva, bademi,le{nici, susam, leblebii, kikiriki.• Drugo: ~ist kakao, ~okolado za gotvewe(bez mleko), margarin bez kazein,alkoholen ocet, ovo{en ocet (bez jabolko igrozje, a ako se sproveduva dieta na gabi,toga{ ne smee ni vinski ocet).Prehranbeni produkti {to ne smee da sezemaat vo dietata bez gluten i kazein, seslednive:• mleko i mle~ni proizvodi (sirewe,krem-sirewe, jogurt, pavlaka, kiselo mleko);• p~enica i proizvodi od p~enica (testenini,p~eni~na pasta, bra{na);• ja~men i proizvodi od ja~men (bra{no);• oves i proizvodi od ovesot (bra{no);• ‘r` i proizvodi od ‘r` (16).• Protein sources: pork, lamb, veal, beef,chicken, turkey, duck, pheasant, crabs, seashells,tuna, trout, salmon, sardines, eggs, vegetable proteins– soybean, soybean shells, soybean yoghurt.• Flour: rice flour, soybean flour, starch, cornflour, groats, lentil flour, bean flour, chestnut flour,millet flour.• Vegetables: lettuce, leek, garlic, carrot, celery,parsley, white potatoes, tomatoes, spinach, beet,green paprika, peas, green beans, soybean, bean,cucumber, pumpkin, squash, cabbage, cauliflower,corn, rape.• Fruit: pears, quince, figs, oranges, mandarins,strawberries, raspberries, blackberries, pineapple,melon, water melon, coconut, dates, bilberries,apricots, peaches, plums, prunes, cherries.• Drinks: fruit juices, carrot juice, beet juice,tomato juice.• Grains and seeds: nuts, sunflower seeds,pumpkin seeds, almonds, hazelnuts, sesame, chickpea,peanuts.• Other: pure cocoa, cooking chocolate (withoutmilk), margarine free of casein, vinegar, fruit vinegar(without apple and grapes, and in diet withfungi, then wine vinegar must not be used).Food products that must not be used in diet free ofgluten and casein are the following:• milk and milk products (cheese, feta cheese,yoghurt, cream, sour milk);• Wheat and wheat products (pastas and flour);• Barley and barley products (flour);• Oats and oat products (flour);• Rye and rye products (16).Zaklu~okBiomedicinskata terapija na autizmot eaktuelen metod i su{tinski e da se sfatiConclusionBiomedical therapy of autism is a current methodand it is essential to consider that medicine is notDEFEKTOLO[KA TEORIJA I PRAKTIKA 2004; 3-4: 43-5655

MEDICAL TREATMENTdeka lekovite ne se zameni za drugite vi -dovi tretman na autizmot. Golem broj decaso primena na ovie lekovi stanuvaat pomirni,pomalku hiperaktivni, so zgolemenovnimanie, reducirana agresija i avtoagresija,dodeka nezainteresiranite deca stanuvaatpootvoreni.Analiziranite vidovi biomedicinski terapiimo`ebi, u{te nemaat doka`ana vrednost,no vo nekoi studii imale pozitivnirezultati, odnosno vodele kon podobruvawena autisti~nata simptomatologija. Sekako,potrebni se natamo{ni istra`uvawa zaradidoutvrduvawe na vistinskata vrednost naovie lekovi. Vo na{ata sredina mnogu odnavedenite lekovi voop{to ne se zemaat.Zatoa se nametnuva potrebata od po~nuvawena terapijata na autizmot so nekoj od ovievidovi tretman i vo na{ava dr`ava.replacement for other kinds of treatment of autism.A large number of children with implementatio n ofthis medicine become calmer, less hyperactive,with increased attention, reduced aggression andself-aggression, while uninterested children becomeopener.The analyzed types of biomedical therapies mightnot have approved value, but they showed pos itiveresults in some studies, i.e. they led towards im -provement of autistic symptoms. Certainly, furtherresearch is needed in order to determine the realvalue of the medicine. A great number of listedmedicines are not used in our country. Therefore, itis necessary to start therapy in autism with sometypes of these treatments.Literatura / References1. American Psychiatric Association. Diagnostic andstatistical manual of mental disorders (4 thed.), Waschington,DC, 1994.2. Posey DJ and McDougle CJ. Pharmacotherapeuticmanagement of autism. Exp Opin Pharmacother 2001; 2(4): 587 -600.3. Winslow JT and Insel TR. The social deficits of theoxytocin knockout mouse. Neuropeptides 2002; 36: 221-229.4. Modahl C, Green L, Fein D, Morris M, WaterhouseL, Feinstein C, & Levin H. Plasma oxytocin levels inautistic children. Biol Psychiatry 1998; 43: 270-277.5. Hollander E, Novotny S, Hanratty M, Yaffe R, De-Caria CM, Aronowitz BR and Mosovich S. Oxytocininfusion reduces repetitive behavior in adults with au tisticand Asperger’s disorders. Neuropsychopharmacology2003; 28: 193 -198.6. Fernell E, Watanabe Y, Adolfsson I, Tani Y,Bergstrom M, Hartvig P, Lilja A, von Knorring AL,Gillberg C, and Langstrom B. Possible effects of tetrahydrobiopterintreatment in six children with autismclinicaland positron emission tomography data: a pilotstudy. Developmental Medicine and Child Neurology1997; 39: 313 -318.7. Danysz W. CX-516 Cortex pharmaceuticals. CurrentOpinion in Investigational Drugs 2002; 3 (7) : 1081-1088.8. Whitman TL, and Kolberg KJ. Educational and BiomedicalInterventions. In: Whitman TL, ed. The developmentof autism a self-regulatory perspective. JessicaKingsley Publishers, London and New York, 2004; Ch 5:176-233.9. Beck G, Beck V, and Rimland B. Unlocking the potentialof secretin. San Diego, 1998: The Autism ResearchInstitute.10. Kern JK , Miller VS , Evans PA, and Trivedi MH.Efficacy of porcine secretin in children with autism andpervasive developmental disorder. Journal of Autism andDevelopmental Disorders 2002; 32 (3): 153-160.11. Shaw W. Yeasts and fungi. How to control them. In:William Shaw, editor: Biological Treatments for Autismand PDD. The Great Plains Laboratory, Inc; 2000: 66-94.12. Rimland B. The use of vitamin B6, magnesium, andDMG in the treatment of autistic children and adults. In:William Shaw, editor: Biological Treatments for Autismand PDD. The Great Plains Laboratory, Inc; 2000: 176-195.13. Dolske MC, Spollen J, McKay S , Lancashire E, andTolbert L. A preliminary trial of ascorbic acid as supplementaltherapy for autism. Progress in Neuropsychopharmacologyand Biological Psychiatry 1993; 17:765-774.14. Rimland B. What is the right dosage for Vitamin B6,DMG, and other nutrients useful in autism? Autism ResearchReview International 1997; 11 (4): 3.15. Ziegler C, et al. Alpha-lipoic acid in the treatment ofdiabetic neuropathy in Germany: current evidence fromclinical trials. Experimental & Clinical Endocrinology &Diabetes 1999; 107 (7): 421-430.16. Selakovic M. Autizam i dijeta. Brošura za roditelje.Beograd, 2001; 4-5.56JOURNAL OF SPECIAL EDUCATION AND REHABILITATION 2004; 3-4: 43-56