Reply: Attenuated variants of Lesch-Nyhan disease: the case of King James VI/I

Sir, In the 13th century, Jacobus de Voragine described how God punished the murders of St Thomas. The perpetrators were inflicted with a terrible syndrome that included self-injurious behaviour, compulsive–aggressive acts, intellectual deficiency, gout and renal failure. This syndrome is so highly characteristic of Lesch–Nyhan disease that Beck speculated Jacobus must have had first-hand experience with a patient with the disease (Beck, 1991).Now P. Garrard et al. (2010) recall the medical disorder of King James VI/I. As a child, there was evidence of motor and speech delay with awkward coordination that persisted without worsening throughout adulthood. His condition has been compared to cerebral palsy, with prominent writhing …