The control of human locomotion uses afferent information from many sources within the visual, vestibular, and proprioceptive systems: central generators and programmes interacting with peripheral reflexes represent only a portion of the mechanisms involved. Spinal-reflex pathways and descending tracts converge on common spinal interneurons and thus play an integrative role in regulating the input from descending tracts and spinal reflexes. The weakness of studies carried out on humans in this field is due to the fact that human motor-control mechanisms can only usually be surmised by indirect methods such as knowledge gained from animal experiments. Although there are common features between the pattern of activity and the underlying neuronal mechanisms during quadripedal locomotion in cats and that seen during bipedal gait of humans, there are also distinct differences.

Cranial ultrasound abnormalities, especially a white-matter echolucency, predict disability (Paneth and Pinto-Martin 1990, Whitaker et al. 1990, Dammann and Leviton 1997), but with limitations. For example, half of very preterm infants who develop cerebral palsy (CP) do not have any abnormality of the white matter (Pinto-Martin et al. 1995, O'Shea et al. 1998). In addition, echolucencies that predict spastic CP are seldom located with descending fibers from the motor cortex (Rogers et al. 1994). These findings have led to the ‘tip of the iceberg’ hypothesis which postulates that cranial ultrasound scans do not detect the entirety of the white-matter damage (Leviton and Gilles 1996).

The study of developmental disabilities, not being confined to one medical field, poses a challenge in evaluating outcomes research. It is a multidisciplinary area of study which encompasses health-care, rehabilitation, psychosocial, educational, and biotechnology specialties and involves biological, social, and behavioral effects of intervention. Consequently, there is a lack of consistency in what has been studied, how the outcomes have been measured, and where these results have been recorded. Naturally, these disparate outcomes data need to be consolidated in such a way that comparison of treatments can be made, within and across professional disciplines.

Three children with CHARGE association (coloboma, heart defect, atresia of the choanae, retarded growth and development, genital hypoplasia, ear anomalies and hearing defects) as well as concomitant autistic disorder are reported. Two of the children also had mental retardation. Several types of cerebral maldevelopment/dysfunction have been reported in CHARGE association. With regard to aetiology, involvement of the neural crest has been suggested. Autism in CHARGE association may represent a neuro-endocrine dysfunction. Children with a CHARGE association have many medical problems and therefore autistic behaviour can easily be overlooked. A multidisciplinary approach with respect to assessment, treatment, and habilitation is of vital importance.

Lerner, a dermatologist who isolated melatonin (MLT) in 1959, was the first to report on its hypnotic properties, and was also the first to self-administer this hormone. Later, in 1971, Anton-Tay and coworkers injected MLT into volunteers who quickly fell asleep. In adults, MLT treatment appears to have beneficial effects in those who have sleep disorders due to delayed sleep onset, shift work, and jet lag. MLT can enhance adaptation to forced phase shift in simulated shift-work and jet-lag conditions. However, better controlled, long-term studies are still required. MLT may also benefit certain types of adult insomnia.

Two subjects with ictal hemiparesis are described. Both children presented with evolving paresis associated with seizure activity. Structural neuroimaging remained consistently normal, although EEG demonstrated slow-wave activity, and SPECT scanning in one child showed perfusion asymmetry. Both children had resolution of the hemiparesis when seizure activity was adequately controlled. The historically proposed pathophysiology of ictal hemiparesis is that of inhibition of the somatosensory and motor areas of the cortex. The presence of an evolving hemiparesis and seizure activity associated with normal neuroimaging should prompt consideration of ictal hemiparesis. Confirmation of this rare diagnosis can only be made when seizure control leads to resolution of the paresis.

Congenital paraplegia, with partial improvement over the first months of life, occurred in a female neonate born at 35 weeks' gestation, whose mother had suffered hypotension and hypoxaemia due to anaphylaxis 12 weeks earlier. Our patient subsequently had an acute encephalopathy during a respiratory illness with later developmental delay. We speculate that the baby's paraplegia resulted from spinal-cord ischaemia in utero. The aim of this report is to describe the spinal presentation.

Although no references can be given, the following experience is firmly established in the author's memory as a true account, and has certainly always focused his interest on the possible diagnosis of familial temporal epilepsy. Many years ago on a tour of Longleat House, Wiltshire, a guide pointed out a painting of a woman in an advanced stage of pregnancy. Apparently she had asked to be painted at that time because she was sure that she would die in childbirth (which, in fact, she did). The guide added that this woman was also well known for meeting herself in the passages of Longleat House. A few years later, when working in London as a neurological registrar, the author was reading a newspaper when he noted a paragraph describing the conversion of Holland House, London. A number of paintings from the house were described, including one of a woman, again well known for seeing an image of herself in the passages of this building. It eventually transpired that these women were sisters; and there seemed to be a possibility that they both suffered from heautoscopic hallucinations, in which sufferers see themselves carrying out some kind of action, and which are known to occur during complex partial seizures arising in the temporal lobes.

Sleep problems are common in childhood. They are reported in about a quarter of young children, usually in the form of settling difficulties or night waking. The types and frequency of sleep disturbance tend to vary with age and, although some remit spontaneously, a substantial proportion of them persist. Particularly high rates of sleep disturbance occur in children who have learning disabilities, are physically ill, or psychologically disturbed. The immediate effects of sleep problems are important but so, also, are the longer-term effects which may influence the child's physical, psychological, and social development. Persistent sleep disturbance is associated with behavioural disturbance in children and may affect performance in school. Raised levels of maternal stress and impairment of parenting skills have also been reported as a consequence.