A single-center observational study on long-term neurodevelopmental outcomes in children with tuberous sclerosis complex

Abstract

Background: Tuberous sclerosis complex (TSC) is a rare multisystem disorder caused by mutations in the TSC1 or TSC2 gene. More than 90% of patients with TSC develop neurological and/or neuropsychiatric manifestations. The aim of the present study was to determine the developmental and cognitive long-term outcomes of pediatric TSC patients.

Methods: This cross-sectional, monocenter study included pediatric TSC patients who received multidisciplinary long-term care with a last visit between 2005 and 2019. Neurological manifestations and cognitive development (BSID, K-ABC) were analyzed in relation to age and type of mutation.

Results: Thirty-five patients aged 13.5 ± 7.8 years were included in the study. Diagnosis was confirmed genetically in 65.7% of patients (TSC1, 26.1%; TSC2, 65.2%; NMI, 8.7%). Mean age at diagnosis was 1.3 ± 3.5 years; 74.3% of the patients had been diagnosed within the first year of life due to seizures (62.9%) or/and cardiac rhabdomyomas (28.6%). The most common TSC manifestations included structural brain lesions (cortical tubers, 91.4%; subependymal nodules, 82.9%), epilepsy (85.7%), and cardiac rhabdomyomas (62.9%). Mean age at seizure onset was 1.5 ± 2.3 years, with onset in 80.0% of patients within the first two years of life. Infantile spasms, which were the first seizure type in 23.3% of the patients, developed earlier (0.6 ± 0.4 years) than focal seizures (1.8 ± 2.5 years). Refractory epilepsy was present in 21 (70.0%) patients, mild or severe intellectual impairment in 66.6%, and autism spectrum disorders in 11.4%. Severe cognitive impairment (33.3%) was significantly associated with epilepsy type and age at seizure onset (p < 0.05).

Conclusions: The results emphasized the phenotypic variability of pediatric-onset TSC and the high rate of neurological and neuropsychiatric morbidity. Early-onset refractory epilepsy was associated with impaired cognitive development. Children of all ages with TSC require multidisciplinary long-term care and individual early-intervention programs.

Keywords: Antiseizure medication; Autism; Cognition; Rare disease; Refractory epilepsy; Tuberous sclerosis complex.

Fig. 1

Seizure types in tuberous sclerosis complex patients with epilepsy (N = 30) up to the last visit. FBTCS, focal to bilateral tonic–clonic; ISS, infantile spasm syndrome; LGS, Lennox–Gastaut syndrome

Fig. 2

Most frequent antiseizure medications (ASMs) used in patients with epilepsy (n = 30) during the observational period by age group (< 13 years, n = 14; ≥ 13 years, n = 16)

Fig. 3

Neuropsychological functioning in patients with TSC in relation to age. A Patients < / = 42 months of age (N = 11), individual results of GES (black) and BSID (blue). B Patients > 42 months of age: individual results of K-ABC and HAWIK (blue), and patients who were unable to participate in standardized testing due to severe intellectual disability (white). n.s

Fig. 4

Developmental supportive care in relation to age group (N = 30)