The life of James is reviewed and previously-proposed diagnoses are considered. James’s medical history is
discussed in detail and, where possible, examined with validated symptom scales. Using an online database
of neurological diseases, the authors show that James’s symptomatology is compatible with a diagnosis of
Attenuated (mild) Lesch-Nyhan disease; no evidence was found to support a diagnosis of acute porphyria.
In addition, there is evidence of associated Asperger traits which may explain some of the King’s unusual
behavioural and psycho-social features.