Three children with adrenoleukodystrophy (ALD) were treated with allogeneic bone marrow transplantation (BMT) at Huddinge University Hospital, Sweden. Patient 1, a boy aged 9, presented with attention deficit disorder and learning disability; MRI showed demyelination in the frontal lobes which progressed over a 4 year follow-up, in association with mental deterioration. The 2nd and 3rd patients had no symptoms but white matter lesions were present on MRI at diagnosis. One had Addison’s disease at 6 years of age, and ALD was confirmed biochemically and by MRI six months later. He showed worsening of attention deficits before, and he died 18 months after BMT. Patient 3 was the younger brother of patient 2, and ALD and Addison’s disease were diagnosed at 4 years. This boy is healthy 3.5 years after BMT. 
COMMENT. The authors recommend bone marrow transplantation implemented early in the treatment of ALD, even without symptoms, provided that the MRI shows signs of demyelination and a suitable donor is available.
Attention deficit disorder was the presenting clinical manifestation of ALD in one of these patients, emphasizing the neurologist’s role in the management of children with ADHD.