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We report a case of a 3-year-old boy with acute muscle weakness that initially affected neck and all four limbs but later vanished from the lower limbs. Pharyngeal palsy was not observed during the course. All deep tendon reflexes were absent. Peripheral nerve conduction studies showed a demyelination pattern in each limb. The patient received intravenous high-dose corticosteroid hormone, followed by two immunoglobulin therapies. His muscle strength gradually improved after treatment and was almost completely restored four months later. We ultimately diagnosed the condition as the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome, in consideration of the patient's muscle weakness of the neck and four limbs, the greater degree of weakness of the upper limbs versus the lower limbs. His clinical presentation was atypical for the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome, as he presented no pharyngeal muscle weakness or anti GT1a antibodies, typical manifestations of the condition.

We have experienced a case of bipolor I disorder complicated by mental retardation and autistic disorder. Acquired daily life activities such as eating, clothing and toileting without assistance were gradually lost during depressive periods, which was consistent with the previous reports. Before losing daily life skills, the patient could no longer perform daily life activities without consecutive instructions. This "waiting-for-instruction" behavior may be an early diagnostic key for major depressive episode in mentally-retarded children and adolescents.

We have seen 9 moderately to severely mentally-retarded autistic children and adolescents who waited for small-step instructions to perform previously acquired daily life activities (called "waiting-for-instruction" behavior). None of these patients were capable of expressing their depressive mood. All cases were considered to meet the criteria for major depressive episode described in DSM-IN. The "waiting-for-instruction" behavior was suggested to be a diagnostic key for depressive state in mentally retarded children and adolescents. GAF scales for depressive symptoms including the "waiting-for-instruction" behavior improved in 7 of these 9 cases with fluvoxamine. Risperidone and valproate sodium were useful for these symptoms in patients who were not responsive to fluvoxamine. Therefore, there is a possibility that they met the criteria for bipolar II disorder in DSM-IV.

We has been 13 cases of conduct disorder (CD) with developmental disabilities for 10 years. These cases were judged as pre-delinquent states at 8.9 years old (average) and as CD at 12.5 years old. All of these children had been maltreated by their parents. Except for 4 cases who were in juvenile reformatory or prison, 5 of 9 cases were transferred to protective custodial institutions. Custodial intervention could successfully amend CD symptoms in 4 cases. Compared with a gender-matched control group with the same developmental disabilities, the CD group showed a significantly higher rate of maltreatment and a higher divorce rate among the parents. The number of parents with psychiatric disorders was not significantly different between the two groups, although parents of the control group were receiving psychiatric treatment significantly more often than those of CD group. This study suggested that therapeutic intervention is important for preventing CD to not only in children but also in their parents. Further investigations on the measures to intervene in families with a pre-delinquent child is required.

We report a 13-year-old girl with dentatorubal-pallidoluysian atrophy (DRPLA), presenting clinically as progressive myoclonic epilepsy. The action myoclonus, which severely impaired her daily life, was markedly improved by administration of piracetam, a drug reportedly useful for myoclonus of cortical origin. In our case, piracetam effectively suppressed severe subcortical myoclonus of DRPLA, suggesting that the drug may be useful in the treatment of both cortical, and subcortical myoclonus.

A case of forced normalization in childhood is presented. When zonisamide was administered to a five-year-old girl with intractable epilepsy, disappearance of seizures was accompanied by severe psychotic episodes such as communication disturbance, personal relationship failure, and stereotyped behavior, which continued after the withdrawal of zonisamide. These symptoms gradually improved by administration of fluvoxamine, however epileptic attacks reappeared. Although most patients with forced normalization are adult and teenager, attention should be paid to this phenomenon as adverse psychotic effects of zonisamide even in young children. Fluvoxamine may be effective for the symptoms.

Five autistic children underwent fluovoxamine administration. Their self-injury and aggressive behaviors did not respond psychotherapy and other medication with haloperidol, carbamazepine. The improvement of the behaviors was excellent in two patients, and partial in one patient. In a patient who received a combination of haloperidol and fluvoxamine, fluvoxamine treatment was discontinued because of severe drowsiness and could not continue. The other patients showed no obvious side effects. These results suggest that fluvoxamine treatment may be indicated for self-injury and aggressive behaviors in autistic children.