Van Geel et al in this issue (pp290–9)1 provide a thorough multidisciplinary analysis of the clinical progression of 22 patients with X-linked adrenoleukodystrophy (X-ALD) who were treated with Lorenzo’s oil (a 4:1 mixture of glyceryl trioleate and glyceryl trierucate). Four patients remained unchanged. One patient improved, 13 worsened, and in five some indices improved and others worsened. Mild to moderate worsening was the most frequent finding and confirms previous reports.

The introduction of Lorenzo’s oil therapy 10 years ago raised high expectations, heightened by the motion picture of the same name. The expectations were based mainly on …