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Myotonic dystrophy type 1 is an autosomal dominant, inherited multiorgan disorder that can affect people of all ages. It is the most prevalent inherited muscular disease in adults. Late diagnosis points to limited knowledge among the medical community that symptoms other than typical muscular symptoms can dominate. The condition often worsens with each generation and some families are severely affected. Significantly delayed diagnosis means a risk of more serious development of the disorder and inadequate symptomatic treatment. We hope that this clinical review article may lead to more rapid diagnosis and better follow-up of this patient group.

Children with muscular diseases constitute an important group in paediatric neurology. Some of the conditions are very serious and require extensive interdisciplinary treatment and facilitation. There is some degree of optimism regarding the possibility of causal treatment in some of the conditions.

Background: Duchenne muscular dystrophy is one of the most severe muscle diseases to affect children. In the last twenty years, treatments have been established that have significantly improved patients' quality of life and life expectancy. The purpose of this article is to outline the main features of the disease and its treatment, and to examine possible future treatment options., Method: The article is based on a literature search in PubMed, current international guidelines and our own clinical experience., Results: Close monitoring by an interdisciplinary rehabilitation team forms the basis of treatment. Treatment with glucocorticoids can slow disease progression and improve motor function in the short term. The treatment may cause side effects, which must be monitored and which may require intervention. A not insignificant proportion of patients have cognitive and neuropsychiatric problems that must be addressed. Active intervention in response to signs of respiratory or cardiac failure is important. More causal treatment of Duchenne muscular dystrophy is under testing and offers cautious hope for future patients., Interpretation: With improved treatment and increased life expectancy come new challenges for patients with Duchenne muscular dystrophy and their families, as well as new demands on the support services. This patient group requires close and comprehensive follow-up, also in the transition from child to adult.

Background: Infantile spasms are an epileptic manifestation typical of infancy. The spasms may be associated with a wide spectrum of brain abnormalities and diseases, but coexisting pathology is not always found. Prognosis depends to a substantial extent on the underlying condition. Most of the traditional antiepileptics are not effective. Adrenocorticotropic hormone (ACTH) and more recently vigabatrin are the most common first-line medications., Material and Methods: We have performed a literature search mainly in the PubMed database on the treatment of infantile spasms. The results are discussed in relation to Norwegian practice, for which the Norwegian Paediatric Society's recommendations are the main guidelines., Results/interpretation: Vigabatrin has emerged as an accepted first-line medication for infantile spasms in Norway and many other countries, although it has not been shown that this therapy in general is as effective as ACTH/steroids. Well-designed treatment studies have been difficult to carry out. Until the final results of such ongoing studies should give different signals, it seems reasonable to continue to give vigabatrin before hormones. Oral steroids can probably be tried before ACTH, although a firm conclusion about this has yet to be drawn.

Background: Pyridoxine-dependent seizures is an autosomal, recessively inherited inborn error of metabolism with recurrent long-lasting seizures with onset usually in infancy, but also up to three years of age. The seizures are resistant to conventional anticonvulsants. The condition ends fatally if diagnosis and administration of pyridoxine (vitamin B6 ) in pharmacological doses is delayed too long., Material and Methods: A ten-year-old girl who we believe is affected with this condition is presented. A review of the condition based on relevant literature is given., Results and Interpretation: The disorder is rare, but may be underdiagnosed. This case report highlights the serious convulsive condition, the problems in diagnosis and treatment, the delayed development before diagnosis and a very positive development during pyridoxine treatment. The condition is variable in clinical expression, and a variety of clinical seizure types may be seen. Diagnosis is clinical and based on response to pyridoxine administration. The pyridoxine dose needed varies, and the aim of treatment is seizure control as well as optimal intellectual development. Prognosis is variable; many are retarded, especially in their speech development. A gene on chromosome 5 is linked to the disorder, but the gene and its product are unknown.

In the revised diagnostic systems ICD-10 and DSM-IV Asperger's syndrome is listed as a subgroup under Pervasive developmental disorders. It has been argued that persons with this syndrome have similar characteristics as high functioning autists. The knowledge now available about autism is useful for understanding Asperger's syndrome, also when it comes to treatment strategies. The authors discuss differential diagnoses and assessment programmes.

The use of psychotropic drugs in a child psychiatric outpatient clinic and a child and adolescent psychiatric outpatient clinic was studied for 1988 and 1989, using information supplied in the new registration forms for patients in child and adolescent psychiatry in Norway. 1,052 patients were registered during the period in question, which means 1-2% of the local population in the actual age groups. The percentage of patients who received psychotropic/antiepileptic drugs varied from 6.5% to 15.2%. Stimulants, usually given to hyperactive children, were clearly the medication most often prescribed. Other forms of treatment were also registered, and it seems that psychotropic drugs are given only as a supplement to patients in need of a broad therapeutic approach. The registration forms provide useful and important knowledge in the field of child and adolescent psychiatry.