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Both parents or all persons involved in everyday treatment and care B. The patient C. The paediatric metabolic specialist D. The dietician E. The psychologist F. The interpreter where necessary It is often argued that too many people would demand too much from the family and make successful communication impossible. According to our experience, families appreciate very much if they are introduced to the whole team. It is also argued that it is too time-consuming and therefore not efficient to include the whole team, but it will be more time consuming to correct families’ perceptions of apparent divergent information given by different members of a team.

In addition to these symptoms, tyrosinemia type II is often associated with neurological symptoms and various degrees of mental retardation and intellectual deficiency, as is tyrosinemia 50 Disorders of Tyrosine Degradation type III, in which there are no other symptoms. There is no evidence that these symptoms can be improved or prevented by a further reduction of the tyrosine level, but, when these cases are picked up by neonatal screening or diagnosed in infancy, it seems appropriate to use a more strict control of the tyrosine level during early childhood.

Arch Inter Med 162:1647–1648 8. Clayton PT, Surtees RAH, DeVile C, Hyland K, Heales SJR (2003) Neonatal epileptic encephalopathy. Lancet 361:1614 9. Hoffmann GF, Surtees RAH, Wevers RA (1998) Cerebrospinal fluid investigations for neurometabolic disorders. Neuropediatrics 29:59–71 10. Hoffmann GF, Assmann B, Br¨autigam C, Dionisis-Vici C, H¨aussler M, Klerk J de, Naumann M, Steenbergen-Spanjers G, Strassburg HM, Wevers RA (2003) Tyrosine hydroxylase deficiency causes progressive encephalopathy and dopa-nonresponsive dystonia.

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