Rett syndrome (RTT, Mendelian Inheritance in Man [MIM] 312750) is a rare genetic disorder leading to severe and progressive intellectual disability, almost exclusively affecting female children with an incidence of approximately 1 in 15 000 live births. It was first characterized in 1966 by Andreas Rett, a psychiatrist from Austria who specialized in neurodevelopmental disorders. 1 However, it was not until two decades later that RTT became officially recognized after a Swedish neurologist, Bengt Hagberg, observed patients with similar symptoms and decided, with French and Portuguese colleagues, to publish an article describing the syndrome. 2 RTT alone accounts for 10% of cases of profound intellectual disability of genetic origin in females. 3 RTT is a severe developmental disorder. 4,5 Females with RTT begin life apparently 'healthy'. However, from 6 to 18 months of age they undergo regression of early milestones, with deterioration of motor skills, eye contact, speech, and motor control; they then develop a range of neurological symptoms, including anxiety, respiratory dysrhythmias, and seizures. 5 Since most cases are sporadic, identifying a causative locus has been fraught with difficulties. Initially RTT was considered a purely nervous system pathology including neurons and astrocytes but in recent years it has emerged that RTT is also a neurometabolic pathology involving cholesterol abnormalities. 6,7