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Lindsay N, Runicles A, Johnson MH, Jones EJH, Bolton PF, Charman T, Tye C. Early development and epilepsy in tuberous sclerosis complex: A prospective longitudinal study. Dev Med Child Neurol 2024; 66:635-643. [PMID: 37885138 DOI: 10.1111/dmcn.15765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 10/28/2023]
Abstract
AIM To characterize early changes in developmental ability, language, and adaptive behaviour in infants diagnosed with tuberous sclerosis complex (TSC), and determine whether clinical features of epilepsy influence this pathway. METHOD Prospective, longitudinal data were collected within the Early Development in Tuberous Sclerosis (EDiTS) Study to track development of infants with TSC (n = 32) and typically developing infants (n = 33) between 3 and 24 months of age. Questionnaire and observational measures were used at up to seven timepoints to assess infants' adaptive behaviour, developmental ability, language, and epilepsy. RESULTS A significant group by age interaction effect showed that infants with TSC had lower adaptive functioning at 18 to 24 months old (intercept = 88.12, slope estimate = -0.82, p < 0.001) and lower developmental ability scores from 10 months old (intercept = 83.33, slope estimate = -1.44, p < 0.001) compared to typically developing infants. Early epilepsy severity was a significant predictor of these emerging developmental (R2 = 0.35, p = 0.004, 95% confidence interval [CI] -0.08 to -0.01) and adaptive behaviour delays (R2 = 0.34, p = 0.004, 95% CI -0.05 to -0.01]). Lower vocabulary production (intercept = -1.25, slope = -0.12, p < 0.001) and comprehension scores (intercept = 2.39, slope estimate = -0.05, p < 0.001) in infants with TSC at 24 months old were not associated with epilepsy severity. INTERPRETATION Divergence of developmental ability and adaptive functioning skills occur in infants with TSC from 10 and 18 months, respectively. Associations between early epilepsy severity and impaired development supports the importance of early intervention to reduce seizure severity.
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Affiliation(s)
- Natasha Lindsay
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Abigail Runicles
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mark H Johnson
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Emily J H Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Patrick F Bolton
- Department of Child & Adolescent Psychiatry, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Tye
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Mammadova D, Vecko J, Hofmann M, Schüssler SC, Deiters L, Canda A, Wieland AK, Gollwitzer S, Hamer H, Trollmann R. A single-center observational study on long-term neurodevelopmental outcomes in children with tuberous sclerosis complex. Orphanet J Rare Dis 2023; 18:349. [PMID: 37946245 PMCID: PMC10637019 DOI: 10.1186/s13023-023-02959-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
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.
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Affiliation(s)
- D Mammadova
- Department of Pediatric and Adolescent Medicine, Pediatric Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestr. 15, 91054, Erlangen, Germany
| | - J Vecko
- Department of Pediatric and Adolescent Medicine, Pediatric Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestr. 15, 91054, Erlangen, Germany
| | - M Hofmann
- Department of Pediatric and Adolescent Medicine, Pediatric Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestr. 15, 91054, Erlangen, Germany
| | - S C Schüssler
- Department of Pediatric and Adolescent Medicine, Pediatric Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestr. 15, 91054, Erlangen, Germany
| | - L Deiters
- Department of Pediatric and Adolescent Medicine, Pediatric Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestr. 15, 91054, Erlangen, Germany
| | - A Canda
- Department of Pediatric and Adolescent Medicine, Pediatric Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestr. 15, 91054, Erlangen, Germany
| | - A K Wieland
- Department of Pediatric and Adolescent Medicine, Pediatric Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestr. 15, 91054, Erlangen, Germany
- Center of Rare Diseases Erlangen (ZSEER), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S Gollwitzer
- Department of Neurology, Epilepsy Center, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Center of Rare Diseases Erlangen (ZSEER), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Hamer
- Department of Neurology, Epilepsy Center, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Center of Rare Diseases Erlangen (ZSEER), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatric and Adolescent Medicine, Pediatric Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestr. 15, 91054, Erlangen, Germany.
- Center of Rare Diseases Erlangen (ZSEER), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Disconnection surgery to cure or palliate medically intractable epileptic spasms: a retrospective study. J Neurosurg Pediatr 2022. [PMID: 37522649 DOI: 10.3171/2022.2.peds21522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Surgery is a treatment option for medically intractable epileptic spasms (ESs). However, outcomes of ES after surgery are not well understood, especially when surgeries aimed at seizure palliation are included. The purpose of the present study was to 1) investigate the proportion of favorable postoperative ES outcomes, 2) explore the preoperative factors related to favorable postoperative ES outcomes, and 3) examine the timing of ES recurrence after disconnection surgeries, including both curative and palliative indications.
METHODS
This retrospective study included patients who underwent disconnection surgery for medically intractable ES at the authors’ institution between May 2015 and April 2021. Patients with suggested focal-onset ES based on preoperative evaluations initially underwent lobar disconnection. Patients with suggested generalized or unknown-onset ES underwent corpus callosotomy (CC). If evaluations after initial CC showed focalized or lateralized change, they were considered secondarily revealed focal-onset ES, and lobar disconnection was performed. ES outcomes were evaluated using the International League Against Epilepsy classification. ES outcomes were divided into classes 1–4 as favorable outcomes and classes 5 and 6 as unfavorable outcomes. The relationship between the favorable postoperative ES outcomes and the following preoperative factors was analyzed: sex, age at onset (< or > 1 year), duration between seizure onset and initial surgery (< or > 2 years), type of seizure at onset (ES or others), presence of other types of seizures, substrate, hypsarrhythmia, and MRI abnormalities. The period between the last surgery and ES recurrence was also analyzed.
RESULTS
A total of 41 patients were included, of whom 75.6% achieved favorable ES outcomes. A longer seizure duration between seizure onset and initial surgery, presence of hypsarrhythmia, and positive MRI findings led to poorer postoperative ES outcomes (p = 0.0028, p = 0.0041, and p = 0.0241, respectively). A total of 60.9% of patients had ES recurrence during the follow-up period, and their ES recurred within 13 months after the last surgery.
CONCLUSIONS
Disconnection surgery is an effective treatment option for medically intractable ES, even when the preoperative evaluation suggests a generalized or unknown onset.
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Riikonen R. Could prevention of infantile spasms have been possible in a historical cohort of 31 tuberous sclerosis patients? Eur J Paediatr Neurol 2021; 35:153-157. [PMID: 34731702 DOI: 10.1016/j.ejpn.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Efforts to prevent epilepsy in infants with tuberous sclerosis complex (TSC) has been the focus of EPISTOP. PURPOSE The present study was carried out to evaluate whether prevention could have been realistic. METHODS A retrospective analysis by hospital chart review of 31 patients with TSC and infantile spasms (practically all patients) admitted to two tertiary hospitals, Children's Hospital, University of Helsinki and Kuopio in 1980-2000. Clinical history, early cognitive development, early clinical signs of TSC, clinical signs of suspicious seizures, first seizures and EEG, response to adrenocorticotropic hormone (ACTH) therapy, EEG and brain imaging were evaluated. RESULTS Early development prior the spasms was apparently normal in 25 (80%). The first EEG ever performed for a child showed hypsarrhythmia in 16 (51%) or modified hypsarrhythmia in 10 (32%). Treatment lag was short (0-4, mean 2 weeks) and the primary response to ACTH favorable in 19 (64%). Etiological diagnostic workup of IS revealed TSC. In one single case (3%) the diagnosis of TSC could be made at birth due to a congenital cardiac rhabdomyoma. Three other rhabomyomas were diagnosed later. In brain imaging, subependymal periventricular calcifications or hypodense areas were seen in every patient at onset of IS. Other organ manifestations of TSC were retinal phakomas (6), polycystic kidneys (2), and renal angiolipomatosis (1). CONCLUSIONS Preventive treatment of epileptic discharges could have been possible in a single case of neonatal rhabdomyoma suggesting that preventive treatment is challenging in everyday practice. The main obstacle is the delay of TSC diagnosis.
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Affiliation(s)
- Raili Riikonen
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland, Postal Address: Yliopistonranta 1, FI-70110, Kuopio, Finland.
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Ihnen SKZ, Capal JK, Horn PS, Griffith M, Sahin M, Martina Bebin E, Wu JY, Northrup H, Krueger DA. Epilepsy Is Heterogeneous in Early-Life Tuberous Sclerosis Complex. Pediatr Neurol 2021; 123:1-9. [PMID: 34343869 PMCID: PMC8487620 DOI: 10.1016/j.pediatrneurol.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Epilepsy in tuberous sclerosis complex (TSC) typically presents with early onset, multiple seizure types, and intractability. However, variability is observed among individuals. Here, detailed individual data on seizure characteristics collected prospectively during early life were used to define epilepsy profiles in this population. METHODS Children aged zero to 36 months were followed longitudinally. Caregivers kept daily seizure diaries, including onset and daily counts for each seizure type. Patients with >70% seizure diary completion and >365 diary days were included. Developmental outcomes at 36 months were compared between subgroups. RESULTS Epilepsy was seen in 124 of 156 (79%) participants. Seizure onset occurred from zero to 29.5 months; 93% had onset before age 12 months. Focal seizures and epileptic spasms were most common. Number of seizures (for median 897 days) ranged from 1 to 9128. Hierarchical clustering based on six metrics of seizure burden (age of onset, total seizures, ratio of seizure days to nonseizure days, seizures per seizure day, and worst seven- and 30-day stretches) revealed two distinct groups with broadly favorable and unfavorable epilepsy profiles. Subpopulations within each group showed clinically meaningful differences in seizure burden. Groups with higher seizure burden had worse developmental outcomes at 36 months. CONCLUSIONS Although epilepsy is highly prevalent in TSC, not all young children with TSC have the same epilepsy profile. At least two phenotypic subpopulations are discernible based on seizure burden. Early and aggressive treatments for epilepsy in TSC may be best leveraged by targeting specific subgroups based on phenotype severity.
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Affiliation(s)
- S. Katie Z. Ihnen
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jamie K. Capal
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul S. Horn
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Molly Griffith
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mustafa Sahin
- Department of Neurology and F.M Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Harvard University, Boston, MA
| | - E. Martina Bebin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Joyce Y. Wu
- Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Darcy A. Krueger
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Specchio N, Curatolo P. Developmental and epileptic encephalopathies: what we do and do not know. Brain 2021; 144:32-43. [PMID: 33279965 DOI: 10.1093/brain/awaa371] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023] Open
Abstract
Developmental encephalopathies, including intellectual disability and autistic spectrum disorder, are frequently associated with infant epilepsy. Epileptic encephalopathy is used to describe an assumed causal relationship between epilepsy and developmental delay. Developmental encephalopathies pathogenesis more independent from epilepsy is supported by the identification of several gene variants associated with both developmental encephalopathies and epilepsy, the possibility for gene-associated developmental encephalopathies without epilepsy, and the continued development of developmental encephalopathies even when seizures are controlled. Hence, 'developmental and epileptic encephalopathy' may be a more appropriate term than epileptic encephalopathy. This update considers the best studied 'developmental and epileptic encephalopathy' gene variants for illustrative support for 'developmental and epileptic encephalopathy' over epileptic encephalopathy. Moreover, the interaction between epilepsy and developmental encephalopathies is considered with respect to influence on treatment decisions. Continued research in genetic testing will increase access to clinical tests, earlier diagnosis, better application of current treatments, and potentially provide new molecular-investigated treatments.
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Affiliation(s)
- Nicola Specchio
- Department of Neuroscience, Bambino Gesu Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies EpiCARE, Piazza S, 00165 Rome, Italy
| | - Paolo Curatolo
- Systems Medicine Department, Child Neurology and Psychiatry Unit, Tor Vergata University Hospital of Rome, 00133 Rome, Italy
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Petrasek T, Vojtechova I, Klovrza O, Tuckova K, Vejmola C, Rak J, Sulakova A, Kaping D, Bernhardt N, de Vries PJ, Otahal J, Waltereit R. mTOR inhibitor improves autistic-like behaviors related to Tsc2 haploinsufficiency but not following developmental status epilepticus. J Neurodev Disord 2021; 13:14. [PMID: 33863288 PMCID: PMC8052752 DOI: 10.1186/s11689-021-09357-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/18/2021] [Indexed: 12/18/2022] Open
Abstract
Background Tuberous sclerosis complex (TSC), a multi-system genetic disorder often associated with autism spectrum disorder (ASD), is caused by mutations of TSC1 or TSC2, which lead to constitutive overactivation of mammalian target of rapamycin (mTOR). In several Tsc1+/- and Tsc2+/- animal models, cognitive and social behavior deficits were reversed by mTOR inhibitors. However, phase II studies have not shown amelioration of ASD and cognitive deficits in individuals with TSC during mTOR inhibitor therapy. We asked here if developmental epilepsy, common in the majority of individuals with TSC but absent in most animal models, could explain the discrepancy. Methods At postnatal day P12, developmental status epilepticus (DSE) was induced in male Tsc2+/- (Eker) and wild-type rats, establishing four experimental groups including controls. In adult animals (n = 36), the behavior was assessed in the paradigms of social interaction test, elevated plus-maze, light-dark test, Y-maze, and novel object recognition. The testing was carried out before medication (T1), during a 2-week treatment with the mTOR inhibitor everolimus (T2) and after an 8-week washing-out (T3). Electroencephalographic (EEG) activity was recorded in a separate set of animals (n = 18). Results Both Tsc2+/- mutation and DSE caused social behavior deficits and epileptiform EEG abnormalities (T1). Everolimus led to a persistent improvement of the social deficit induced by Tsc2+/-, while deficits related to DSE did not respond to everolimus (T2, T3). Conclusions These findings may contribute to an explanation why ASD symptoms in individuals with TSC, where comorbid early-onset epilepsy is common, were not reliably ameliorated by mTOR inhibitors in clinical studies. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-021-09357-2.
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Affiliation(s)
- Tomas Petrasek
- National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic.
| | - Iveta Vojtechova
- National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic.,First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondrej Klovrza
- National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Klara Tuckova
- National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic.,Faculty of Science, Charles University, Prague, Czech Republic
| | - Cestmir Vejmola
- National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic
| | - Jakub Rak
- National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic
| | - Anna Sulakova
- National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic
| | - Daniel Kaping
- National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic
| | - Nadine Bernhardt
- Department of Psychiatry, University Hospital and Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Jakub Otahal
- Department of Developmental Epileptology, Institute of Physiology CAS, Prague, Czech Republic
| | - Robert Waltereit
- Department of Child and Adolescent Psychiatry, University Hospital and Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. .,Department of Child and Adolescent Psychiatry, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
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8
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De Ridder J, Lavanga M, Verhelle B, Vervisch J, Lemmens K, Kotulska K, Moavero R, Curatolo P, Weschke B, Riney K, Feucht M, Krsek P, Nabbout R, Jansen AC, Wojdan K, Domanska-Pakieła D, Kaczorowska-Frontczak M, Hertzberg C, Ferrier CH, Samueli S, Benova B, Aronica E, Kwiatkowski DJ, Jansen FE, Jóźwiak S, Van Huffel S, Lagae L. Prediction of Neurodevelopment in Infants With Tuberous Sclerosis Complex Using Early EEG Characteristics. Front Neurol 2020; 11:582891. [PMID: 33178126 PMCID: PMC7596378 DOI: 10.3389/fneur.2020.582891] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022] Open
Abstract
Tuberous Sclerosis Complex (TSC) is a multisystem genetic disorder with a high risk of early-onset epilepsy and a high prevalence of neurodevelopmental comorbidities, including intellectual disability and autism spectrum disorder (ASD). Therefore, TSC is an interesting disease model to investigate early biomarkers of neurodevelopmental comorbidities when interventions are favourable. We investigated whether early EEG characteristics can be used to predict neurodevelopment in infants with TSC. The first recorded EEG of 64 infants with TSC, enrolled in the international prospective EPISTOP trial (recorded at a median gestational age 42 4/7 weeks) was first visually assessed. EEG characteristics were correlated with ASD risk based on the ADOS-2 score, and cognitive, language, and motor developmental quotients (Bayley Scales of Infant and Toddler Development III) at the age of 24 months. Quantitative EEG analysis was used to validate the relationship between EEG background abnormalities and ASD risk. An abnormal first EEG (OR = 4.1, p-value = 0.027) and more specifically a dysmature EEG background (OR = 4.6, p-value = 0.017) was associated with a higher probability of ASD traits at the age of 24 months. This association between an early abnormal EEG and ASD risk remained significant in a multivariable model, adjusting for mutation and treatment (adjusted OR = 4.2, p-value = 0.029). A dysmature EEG background was also associated with lower cognitive (p-value = 0.029), language (p-value = 0.001), and motor (p-value = 0.017) developmental quotients at the age of 24 months. Our findings suggest that early EEG characteristics in newborns and infants with TSC can be used to predict neurodevelopmental comorbidities.
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Affiliation(s)
- Jessie De Ridder
- Pediatric Neurology, Department of Development and Regeneration, University of Leuven KU Leuven, Leuven, Belgium
| | - Mario Lavanga
- Department of Electrical Engineering (ESAT), STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Birgit Verhelle
- Pediatric Neurology, Department of Development and Regeneration, University of Leuven KU Leuven, Leuven, Belgium
| | - Jan Vervisch
- Pediatric Neurology, Department of Development and Regeneration, University of Leuven KU Leuven, Leuven, Belgium
| | - Katrien Lemmens
- Pediatric Neurology, Department of Development and Regeneration, University of Leuven KU Leuven, Leuven, Belgium
| | - Katarzyna Kotulska
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Rome, Italy.,Child Neurology Unit, Neuroscience and Neurorehabilitation Department, "Bambino Gesù" Children's Hospital, Rome, Italy
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Rome, Italy
| | - Bernhard Weschke
- Department of Child Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Kate Riney
- Neuroscience Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.,University of Queensland School of Clinical Medicine, Brisbane, QLD, Australia
| | - Martha Feucht
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Pavel Krsek
- Department of Paediatric Neurology, Charles University, Second Faculty of Medicine, Motol University Hospital, Prague, Czechia
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Centre for Rare Epilepsies, Imagine Institute, Necker- Enfants Malades Hospital, University Paris Descartes, Paris, France
| | - Anna C Jansen
- Pediatric Neurology Unit, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Konrad Wojdan
- Transition Technologies, Warsaw, Poland.,Institute of Heat Engineering, Warsaw University and Technology, Warsaw, Poland
| | - Dorota Domanska-Pakieła
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Christoph Hertzberg
- Diagnose und Behandlungszentrum für Kinder und Jugendliche, Vivantes Klinikum Neuköln, Berlin, Germany
| | - Cyrille H Ferrier
- Department of Child Neurology, Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Sharon Samueli
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Barbora Benova
- Department of Paediatric Neurology, Charles University, Second Faculty of Medicine, Motol University Hospital, Prague, Czechia
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam Universitair Medisch Centrum, University of Amsterdam, Amsterdam, Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
| | - David J Kwiatkowski
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Floor E Jansen
- Department of Child Neurology, Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Sergiusz Jóźwiak
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland.,Department of Child Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Sabine Van Huffel
- Department of Electrical Engineering (ESAT), STADIUS Centre for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Lieven Lagae
- Pediatric Neurology, Department of Development and Regeneration, University of Leuven KU Leuven, Leuven, Belgium
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9
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Moavero R, Kotulska K, Lagae L, Benvenuto A, Emberti Gialloreti L, Weschke B, Riney K, Feucht M, Krsek P, Nabbout R, Jansen AC, Wojdan K, Borkowska J, Sadowski K, Hertzberg C, Van Schooneveld MM, Samueli S, Maulisovà A, Aronica E, Kwiatkowski DJ, Jansen FE, Jozwiak S, Curatolo P. Is autism driven by epilepsy in infants with Tuberous Sclerosis Complex? Ann Clin Transl Neurol 2020; 7:1371-1381. [PMID: 32705817 PMCID: PMC7448162 DOI: 10.1002/acn3.51128] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/19/2023] Open
Abstract
Objective To evaluate the relationship between age at seizure onset and neurodevelopmental outcome at age 24 months in infants with TSC, as well as the effect on neurodevelopmental outcome of early versus conventional treatment of epileptic seizures with vigabatrin (80–150 mg/kg/day). Methods Infants with TSC, aged ≤4 months and without previous seizures were enrolled in a prospective study and closely followed with monthly video EEG and serial standardized neurodevelopmental testing (Bayley Scales of Infant Development and Autism Diagnostic Observation Schedule). Results Eighty infants were enrolled. At the age of 24 months testing identified risk of Autism Spectrum Disorder (ASD) in 24/80 children (30.0%), and developmental delay (DD) in 26/80 (32.5%). Children with epilepsy (51/80; 63.8%) had a higher risk of ASD (P = 0.02) and DD (P = 0.001). Overall, no child presented with moderate or severe DD at 24 months (developmental quotient < 55). In 20% of children abnormal developmental trajectories were detected before the onset of seizures. Furthermore, 21% of all children with risk of ASD at 24 months had not developed seizures at that timepoint. There was no significant difference between early and conventional treatment with respect to rate of risk of ASD (P = 0.8) or DD (P = 0.9) at 24 months. Interpretation This study confirms a relationship between epilepsy and risk of ASD/DD. However, in this combined randomized/open label study, early treatment with vigabatrin did not alter the risk of ASD or DD at age 2 years.
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Affiliation(s)
- Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Via Montpellier 1, Rome, 00133, Italy.,Child Neurology Unit, Neuroscience and Neurorehabilitation Department, "Bambino Gesù" Children's Hospital, IRCCS, P.zza S. Onofrio 4, Rome, 00165, Italy
| | - Katarzyna Kotulska
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, Warsaw, 04-730, Poland
| | - Lieven Lagae
- Department of Development and Regeneration-Section Pediatric Neurology, University Hospitals KU Leuven, Leuven, Belgium
| | - Arianna Benvenuto
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Via Montpellier 1, Rome, 00133, Italy
| | - Leonardo Emberti Gialloreti
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Via Montpellier 1, Rome, 00133, Italy
| | - Bernhard Weschke
- Department of Child Neurology, Charité University Medicine Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Kate Riney
- Neuroscience Unit, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.,School of Clinical Medicine, University of Queensland, St Lucia, QLD, 4072, Australia
| | - Martha Feucht
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Pavel Krsek
- Department of Paediatric Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Centre for Rare Epilepsies, Necker- Enfants Malades Hospital, University Paris Descartes, Imagine Institute, Paris, France
| | - Anna C Jansen
- Pediatric Neurology Unit-UZ Brussel, Brussels, Belgium
| | - Konrad Wojdan
- Warsaw University of Technology, Institute of Heat Engineering, Warsaw, Poland.,Transition Technologies, ul. Pawia 5, Warsaw, 01-030, Poland
| | - Julita Borkowska
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, Warsaw, 04-730, Poland
| | - Krzysztof Sadowski
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, Warsaw, 04-730, Poland
| | - Christoph Hertzberg
- Diagnose und Behandlungszentrum für Kinder und Jugendliche, Vivantes Klinikum Neuköln, Berlin, Germany
| | - Monique M Van Schooneveld
- Department of Child Neurology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sharon Samueli
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Alice Maulisovà
- Department of Paediatric Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | | | - Floor E Jansen
- Department of Child Neurology, Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sergiusz Jozwiak
- Department of Neurology and Epileptology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, Warsaw, 04-730, Poland.,Department of Child Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Via Montpellier 1, Rome, 00133, Italy
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10
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Galdeano MJ, Guillén Escamilla JE, Fitta García JDJ. Estudio del uso de marcadores discursivos en una adolescente con complejo de esclerosis tuberosa. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2020. [DOI: 10.5209/rlog.67566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
El Complejo de Esclerosis Tuberosa (CET) es un desorden genético que afecta la diferenciación, proliferación y migración celular en los primeros años del desarrollo, esto provoca una amplia variedad de lesiones hamartomatosas que pueden afectar prácticamente cualquier órgano del cuerpo, en especial: la piel, el cerebro, los pulmones, los riñones, el corazón y los ojos. En este contexto, resulta esperable que las personas con CET presenten diversas alteraciones conductuales, cognitivas y lingüísticas. Respecto a las alteraciones del lenguaje, actualmente son escasos los estudios interesados en describir estos déficits, especialmente los que se enfocan en la descripción del lenguaje per se. Por ello, en la presente investigación se analiza la producción lingüística, específicamente el empleo de marcadores discursivos, de una adolescente diagnosticada con CET a través del habla espontánea. Los resultados arrojan que, en nuestra paciente, el uso de marcadores discursivos se mantiene y se emplea de forma convencional, siendo los conectores argumentativos, los metadiscursivos, los reformuladores, formuladores y los modalizadores los más utilizados.
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11
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Rahman MM, Fatema K. Epilepsy in Children with Tuberous Sclerosis Complex: A Prospective Observational Study in Bangladesh. J Epilepsy Res 2020; 10:18-23. [PMID: 32983951 PMCID: PMC7494887 DOI: 10.14581/jer.20004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/27/2020] [Accepted: 06/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose Epilepsy is an important neurologic feature of patients with tuberous sclerosis complex (TSC). Most common seizure types are focal seizure and epileptic spasm. Seizure control often requires multiple antiepileptic drugs. This study has been done to evaluate the seizure types, electro-encephalography (EEG), neuroimaging features, and drug treatment of epilepsy in TSC. Methods This prospective observational study has been conducted on epilepsy patients with TSC at Bangabandhu Sheikh Mujib Medical University from 2011 to 2019. Results Seventy patients with a mean±standard deviation age of 5.64±3.96 years were identified and 57.1% were female. Most common type of seizure was focal seizure (46%). Epileptic spasm occurred in 17% of patients and all of them had seizure onset before 1 year. In 47% of patients EEG showed focal epileptic discharge; hypsarrhythmia was found in most of the patients with epileptic spasm. Majority of the patients needed more than one drug to control seizure. Only 34% of patients were seizure free for at least 12 months and 22.8% had drug resistant epilepsy. Conclusions This study highlights the pattern of seizure, treatment pattern, response to drug, and short-time outcome of children with TSC with epilepsy in a developing country like Bangladesh.
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Affiliation(s)
- Md Mizanur Rahman
- Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kanij Fatema
- Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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12
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Williams ME, Pearson DA, Capal JK, Byars AW, Murray DS, Kissinger R, O'Kelley SE, Hanson E, Bing NM, Kent B, Wu JY, Northrup H, Bebin EM, Sahin M, Krueger D. Impacting development in infants with tuberous sclerosis complex: Multidisciplinary research collaboration. ACTA ACUST UNITED AC 2020; 74:356-367. [PMID: 30945897 DOI: 10.1037/amp0000436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Tuberous Sclerosis Complex Autism Center of Excellence Network (TACERN) is a 6-site collaborative conducting longitudinal research on infants with tuberous sclerosis complex (TSC), focused on identifying early biomarkers for autism spectrum disorder (ASD). A multidisciplinary research team that includes the specialties of psychology, neurology, pediatrics, medical genetics, and speech-language pathology, its members work together to conduct studies on neurological status, brain structure and function, neurodevelopmental phenotype, and behavioral challenges in this population. This article provides insights into the roles of the multidisciplinary multisite team and lessons learned from the collaboration, in terms of research as well as training of future researchers and clinicians. In addition, the authors detail the major findings to date, including those related to the identification and measurement of early symptoms of ASD, relationship between seizures and early development, and early biomarkers for epilepsy and developmental delay in infants and young children with TSC. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Hope Northrup
- University of Texas Health Science Center at Houston
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13
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Savini MN, Mingarelli A, Peron A, La Briola F, Cervi F, Alfano RM, Canevini MP, Vignoli A. Electro-clinical and neurodevelopmental outcome in six children with early diagnosis of tuberous sclerosis complex and role of the genetic background. Ital J Pediatr 2020; 46:36. [PMID: 32216820 PMCID: PMC7099780 DOI: 10.1186/s13052-020-0801-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Seizures in individuals affected by tuberous sclerosis complex (TSC) commonly develop in the first year of life, are often preceded by a progressive deterioration of the electroencephalogram (EEG), and likely influence developmental outcome. Although early diagnosis of TSC has offered a tremendous opportunity to monitor affected patients before seizure onset, reports of the neurological manifestations of TSC in infants before seizure onset are still scarce. Here we describe early EEG activity, clinical and genetic data and developmental assessment in a group of TSC infants, with the aim of identifying possible prognostic factors for neurodevelopmental outcome. Methods We report on six infants diagnosed with TSC pre- or perinatally, who underwent serial Video-EEG recordings during the first two years of life. EEGs were classified based on distribution and intensity of interictal epileptiform discharges, and Vigabatrin was introduced in case of ictal discharges. Psychomotor development, cognitive functioning and behavioral problems were assessed through standardized scales. Molecular testing included analysis for point mutations and deletions/duplications in TSC1 and TSC2. Results EEG abnormalities appeared at a mean age of 4 months. Four of the six patients developed seizures. EEG abnormalities preceded the onset of clinical seizures in all of them. The two individuals with good seizure control showed normal development, while the other two exhibited psychomotor delays. The patients who did not develop seizures had normal development. A pathogenic variant in the TSC2 gene was detected in all patients but one. The one without a mutation identified did not develop seizures and showed normal neurodevelopment. Of note, the two patients presenting with the worst outcome (that is, poor seizure control and intellectual/behavioral disability) both carried pathogenic variants in the GAP domain of TSC2. Conclusion Our report supports the importance of EEG monitoring before seizure onset in patients with TSC, and the correlation between prompt seizure control and positive neurodevelopmental outcome, regardless of seizure type. Our results also indicate a possible role of the genetic background in influencing the outcome.
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Affiliation(s)
- M N Savini
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy
| | - A Mingarelli
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Milan, Italy
| | - A Peron
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy. .,Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Human Pathology and Molecular Pathology Unit, San Paolo Hospital, Milan, Italy.
| | - F La Briola
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Milan, Italy
| | - F Cervi
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Milan, Italy
| | - R M Alfano
- Human Pathology and Molecular Pathology Unit, San Paolo Hospital, Milan, Italy
| | - M P Canevini
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy
| | - A Vignoli
- Child Neuropsychiatric Unit - Epilepsy Center, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy
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14
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Tye C, Mcewen FS, Liang H, Underwood L, Woodhouse E, Barker ED, Sheerin F, Yates JRW, Bolton PF. Long-term cognitive outcomes in tuberous sclerosis complex. Dev Med Child Neurol 2020; 62:322-329. [PMID: 31538337 PMCID: PMC7027810 DOI: 10.1111/dmcn.14356] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 01/10/2023]
Abstract
AIM To investigate the interdependence between risk factors associated with long-term intellectual development in individuals with tuberous sclerosis complex (TSC). METHOD The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of individuals with TSC. In phase 1 of the study, baseline measures of intellectual ability, epilepsy, cortical tuber load, and mutation were obtained for 125 children (63 females, 62 males; median age=39mo). In phase 2, at an average of 8 years later, intellectual abilities were estimated for 88 participants with TSC and 35 unaffected siblings. Structural equation modelling was used to determine the risk pathways from genetic mutation through to IQ at phase 2. RESULTS Intellectual disability was present in 57% of individuals with TSC. Individuals without intellectual disability had significantly lower mean IQ compared to unaffected siblings, supporting specific genetic factors associated with intellectual impairment. Individuals with TSC who had a slower gain in IQ from infancy to middle childhood were younger at seizure onset and had increased infant seizure severity. Structural equation modelling indicated indirect pathways from genetic mutation, to tuber count, to seizure severity in infancy, through to IQ in middle childhood and adolescence. INTERPRETATION Early-onset and severe epilepsy in the first 2 years of life are associated with increased risk of long-term intellectual disability in individuals with TSC, emphasizing the importance of early and effective treatment or prevention of epilepsy. WHAT THIS PAPER ADDS Intellectual disability was present in 57% of individuals with tuberous sclerosis complex (TSC). Those with TSC without intellectual disability had significantly lower mean IQ compared to unaffected siblings. Earlier onset and greater severity of seizures in the first 2 years were observed in individuals with a slower gain in intellectual ability. Risk pathways through seizures in the first 2 years predict long-term cognitive outcomes in individuals with TSC.
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Affiliation(s)
- Charlotte Tye
- Department of Child & Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Social Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Fiona S Mcewen
- Department of Child & Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Social Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Department of Biological and Experimental PsychologySchool of Biological and Chemical SciencesQueen Mary University of LondonLondonUK
| | - Holan Liang
- Department of Child & Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Great Ormond Street Hospital NHS TrustLondonUK,Institute of Child HealthUniversity College LondonLondonUK
| | - Lisa Underwood
- Department of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Emma Woodhouse
- Forensic and Neurodevelopmental SciencesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS TrustLondonUK
| | - Edward D Barker
- Department of PsychologyInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Fintan Sheerin
- Department of NeuroradiologyOxford University Hospital NHS Foundation TrustOxfordUK
| | - John R W Yates
- Department of Medical GeneticsCambridge UniversityCambridgeUK
| | - Patrick F Bolton
- Department of Child & Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Social Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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15
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DiStefano C, Wilson RB, Hyde C, Cook EH, Thibert RL, Reiter LT, Vogel-Farley V, Hipp J, Jeste S. Behavioral characterization of dup15q syndrome: Toward meaningful endpoints for clinical trials. Am J Med Genet A 2019; 182:71-84. [PMID: 31654560 DOI: 10.1002/ajmg.a.61385] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/01/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022]
Abstract
Duplication of 15q11.2-q13.1 (dup15q syndrome) is one of the most common copy number variations associated with autism spectrum disorders (ASD) and intellectual disability (ID). As with many neurogenetic conditions, accurate behavioral assessment is challenging due to the level of impairment and heterogeneity across individuals. Large-scale phenotyping studies are necessary to inform future clinical trials in this and similar ID syndromes. This study assessed developmental and behavioral characteristics in a large cohort of children with dup15q syndrome, and examined differences based on genetic subtype and epilepsy status. Participants included 62 children (2.5-18 years). Across individuals, there was a wide range of abilities. Although adaptive behavior was strongly associated with cognitive ability, adaptive abilities were higher than cognitive scores. Measures of ASD symptoms were associated with cognitive ability, while parent report of challenging behavior was not. Both genetic subtype and epilepsy were related to degree of impairment across cognitive, language, motor, and adaptive domains. Children with isodicentric duplications and epilepsy showed the greatest impairment, while children with interstitial duplications showed the least. On average, participants with epilepsy experienced seizures over 53% of their lives, and half of children with epilepsy had infantile spasms. Parents of children with isodicentric duplications reported more concerns regarding challenging behaviors. Future trials in ID syndromes should employ a flexible set of assessments, allowing each participant to receive assessments that capture their skills. Multiple sources of information should be considered, and the impact of language and cognitive ability should be taken into consideration when interpreting results.
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Affiliation(s)
- Charlotte DiStefano
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Rujuta B Wilson
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Carly Hyde
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Edwin H Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Ronald L Thibert
- Department of Neurology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Lawrence T Reiter
- Department of Neurology, Pediatrics, Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Joerg Hipp
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Roche Innovation Center, Basel, Switzerland
| | - Shafali Jeste
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
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16
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The epileptic encephalopathy jungle - from Dr West to the concepts of aetiology-related and developmental encephalopathies. Curr Opin Neurol 2019; 31:216-222. [PMID: 29356691 DOI: 10.1097/wco.0000000000000535] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW We aim to further disentangle the jungle of terminology of epileptic encephalopathy and provide some insights into the current understanding about the aetiology and pathophysiology of this process. We cover also the key features of epilepsy syndromes of infancy and childhood which are considered at high risk of developing an epileptic encephalopathy. RECENT FINDINGS The concept of 'epileptic encephalopathy' has progressively been elaborated by the International League Against Epilepsy according to growing clinical and laboratory evidence. It defines a process of neurological impairment caused by the epileptic activity itself and, therefore, potentially reversible with successful treatment, although to a variable extent. Epileptic activity interfering with neurogenesis, synaptogenesis, and normal network organization as well as triggering neuroinflammation are among the possible pathophysiological mechanisms leading to the neurological compromise. This differs from the newly introduced concept of 'developmental encephalopathy' which applies to where the epilepsy and developmental delay are both because of the underlying aetiology and aggressive antiepileptic treatment may not be helpful. SUMMARY The understanding and use of correct terminology is crucial in clinical practice enabling appropriate expectations of antiepileptic treatment. Further research is needed to elucidate underlying pathophysiological mechanisms, define clear outcome predictors, and find new treatment targets.
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17
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Wilson RB, McCracken JT, Rinehart NJ, Jeste SS. What's missing in autism spectrum disorder motor assessments? J Neurodev Disord 2018; 10:33. [PMID: 30541423 PMCID: PMC6292106 DOI: 10.1186/s11689-018-9257-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Motor delays and impairments in autism spectrum disorders (ASD) are extremely common and often herald the emergence of pervasive atypical development. Clinical accounts of ASD and standardized measures of motor function have identified deficits in multiple motor domains. However, literature describing frequently used standardized motor assessments in children with ASD, their test properties, and their limitations are sparse. METHODS We systematically reviewed the literature to identify the most frequently used standardized motor assessments used to evaluate children with ASD from infancy to early childhood. All assessments included were required to possess reference norms, evaluate more than one motor domain, and have undergone some degree of validation. RESULTS We identified six frequently used standardized measures of motor function per our inclusion and exclusion criteria. We investigated and described in detail the psychometric properties of these assessments, their utility for use with children with ASD, and their individual and overall strengths and limitations. The global strengths of these assessments are the ability to identify early development delays and differences in fine and gross motor function in children with ASD. Global limitations of these studies are lack of validation in individuals with ASD and scoring systems that often miss specific and subtle abnormalities. CONCLUSIONS Standardized assessments of motor function have provided valuable information on motor impairments in ASD. However, significant limitations remain in the use of these measures in children with ASD. Moving forward, it is imperative that standardized measures of motor function receive greater validation testing in children with ASD to assess their potential application given the clinical heterogeneity of this condition. In addition, utilizing quantitative measures of motor function should allow for evaluation and comparison of individuals with ASD across the lifespan with varying cognitive and behavioral abilities.
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Affiliation(s)
- Rujuta B. Wilson
- UCLA Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Room A7-424, Los Angeles, CA 90095 USA
| | - James T. McCracken
- UCLA Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Room A7-424, Los Angeles, CA 90095 USA
| | - Nicole J. Rinehart
- Deakin University, Deakin Child Study Centre, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Geelong, VIC 3125 Australia
| | - Shafali S. Jeste
- UCLA Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Room A7-424, Los Angeles, CA 90095 USA
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18
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Pearson N, Charman T, Happé F, Bolton PF, McEwen FS. Regression in autism spectrum disorder: Reconciling findings from retrospective and prospective research. Autism Res 2018; 11:1602-1620. [PMID: 30475449 DOI: 10.1002/aur.2035] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/21/2018] [Accepted: 09/18/2018] [Indexed: 12/16/2022]
Abstract
The way in which the behavioral manifestations of autism spectrum disorder (ASD) emerge in infancy is variable. Regression-loss of previously acquired skills-occurs in a subset of children. However, the etiology and significance of regression remains unclear. Until recently, investigation of regression relied on retrospective report by parents or examination of home videos from early in life. However, home videos and retrospective report of the nature and timing of regression, and association with factors such as illness or immunization, is potentially subject to bias. The advent of prospective studies of infant siblings at familial high-risk of ASD has the potential to document regression as it occurs. Recent research has suggested that subtle loss of skills occurs in a larger proportion of children with ASD than previously assumed; however, there are few reports of clear-cut regressions, such as that involving dramatic loss of language and other established skills, in the prospective literature. This could be because of the following: clear-cut regression occurs less commonly than parent report suggests, study design limits the potential to detect regression, or there are differences between multiplex and simplex families in the rate of de novo genetic mutations and therefore regression risk. This review will bring together literature from retrospective and prospective research and attempt to reconcile diverging findings, with a specific focus on methodological issues. Changing conceptualizations of regression will be discussed, as well as etiological factors that may be associated with regression. The main challenges that need to be addressed to measure regression in prospective studies will be set out. Autism Research 2018, 11: 1602-1620. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Regression-a loss of previously established skills-occurs in a subset of children with ASD. Parental recall is not always accurate but studying younger siblings of children with ASD, 10-20% of whom will develop ASD, should make it possible to measure regression as it occurs. Clear-cut regression, like loss of language, has not often been reported in infant sibling studies, but recent research suggests that gradual loss of social engagement might be more common. This review looks at the evidence for regression from infant sibling studies and asks how study design affects the likelihood of capturing regression.
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Affiliation(s)
- Niamh Pearson
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley National Health Service (NHS) Foundation Trust, Maudsley Hospital, London, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Patrick F Bolton
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley National Health Service (NHS) Foundation Trust, Maudsley Hospital, London, UK.,Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona S McEwen
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Social, Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Biological & Experimental Psychology, School of Biological & Chemical Sciences, Queen Mary University of London, London, UK
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19
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de Vries PJ, Wilde L, de Vries MC, Moavero R, Pearson DA, Curatolo P. A clinical update on tuberous sclerosis complex-associated neuropsychiatric disorders (TAND). AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:309-320. [PMID: 30117265 DOI: 10.1002/ajmg.c.31637] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022]
Abstract
Tuberous sclerosis complex (TSC) is associated with a wide range of behavioral, psychiatric, intellectual, academic, neuropsychological, and psychosocial difficulties, which are often underdiagnosed and undertreated. Here, we present a clinical update on TSC-associated neuropsychiatric disorders, abbreviated as "TAND," to guide screening, diagnosis, and treatment in practice. The review is aimed at clinical geneticists, genetic counselors, pediatricians, and all generalists involved in the assessment and treatment of children, adolescents and adults with TSC, and related disorders. The review starts with a summary of the construct and levels of TAND, before presenting up-to-date information about each level of investigation. The review concludes with a synopsis of current and future TAND research.
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Affiliation(s)
- Petrus J de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Lucy Wilde
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Magdalena C de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy.,Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Deborah A Pearson
- Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Centre, Houston, Texas
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
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20
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Tye C, Thomas LE, Sampson JR, Lewis J, O'Callaghan F, Yates JRW, Bolton PF. Secular changes in severity of intellectual disability in tuberous sclerosis complex: A reflection of improved identification and treatment of epileptic spasms? Epilepsia Open 2018; 3:276-280. [PMID: 29881807 PMCID: PMC5983114 DOI: 10.1002/epi4.12111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 11/10/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by mutations in TSC1 or TSC2. Epilepsy occurs in 80%-90% of affected individuals during their lifetime, and up to one-third of children with TSC will develop epileptic (infantile) spasms, for which vigabatrin has been shown to be particularly effective. Epilepsy severity and epileptic spasms are consistent markers of risk for the development of intellectual impairment in TSC. Although previous studies demonstrate a bimodal distribution of intellectual ability in TSC, recent findings suggest a unimodal distribution, which may reflect a change in IQ distribution over time. We compared 3 large historical UK cohorts of TSC (n = 331) that show varied distributions of intellectual ability, first ruling out differences in study methodology. Later-born individuals had a higher frequency of reported spasms and higher likelihood of vigabatrin administration, but were less likely to have profound intellectual impairment, compared to the earlier-born individuals. Our findings suggest that epileptic spasms went undetected in the older patients and therefore were not treated, leading to a higher occurrence of profound impairment, whereas the later born cohort had better access to treatment. These findings support the importance of early identification and treatment of seizures in TSC.
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Affiliation(s)
- Charlotte Tye
- Department of Child & Adolescent Psychiatry and MRC Social Genetic & Developmental Psychiatry Centre Institute of Psychiatry, Psychology & Neuroscience King's College London London United Kingdom
| | - Laura E Thomas
- Division of Cancer and Genetics Institute of Medical Genetics Cardiff University School of Medicine Cardiff United Kingdom
| | - Julian R Sampson
- Division of Cancer and Genetics Institute of Medical Genetics Cardiff University School of Medicine Cardiff United Kingdom
| | - Julia Lewis
- Mental Health and Learning Disabilities Division Anuerin Bevan University Health Board Newport United Kingdom
| | - Finbar O'Callaghan
- Institute of Child Health University College London London United Kingdom
| | - John R W Yates
- Department of Medical Genetics University of Cambridge Cambridge United Kingdom
| | - Patrick F Bolton
- Department of Child & Adolescent Psychiatry and MRC Social Genetic & Developmental Psychiatry Centre Institute of Psychiatry, Psychology & Neuroscience King's College London London United Kingdom
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21
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Abstract
Utilizing the multicenter TSC (tuberous sclerosis complex) Natural History Database including 2034 subjects, this study aimed to identify predictors of drug-resistant epilepsy in TSC. Basic epilepsy data were available for 1965 individuals in the database. Supplemental data were further collected from 1546 of these subjects through directed site queries, addressing additional epilepsy characteristics including the presence of drug-resistant epilepsy, therapies trialed, and outcomes of specific therapies. Epilepsy was reported in 86.4% of individuals with TSC. Infantile spasms were reported in 45.2% of individuals and focal seizures were reported in 84.4% of individuals. In those with focal epilepsy, drug resistance was reported in 59.6%, with focal seizure onset prior to age 1 year (odds ratio [OR] 1.9, confidence interval [CI] 1.4-2.5, P < .001), infantile spasms (OR 2.0, CI 1.5-2.5, P < 0.001), and infantile spasms incompletely responsive to therapy (OR 47.6, CI 6.7-333.3, P < 0.001) being associated with an increased likelihood of drug resistance.
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Affiliation(s)
- Anna Jeong
- 1 Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Michael Wong
- 1 Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,3 Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA
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22
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Krueger DA, Sadhwani A, Byars AW, de Vries PJ, Franz DN, Whittemore VH, Filip-Dhima R, Murray D, Kapur K, Sahin M. Everolimus for treatment of tuberous sclerosis complex-associated neuropsychiatric disorders. Ann Clin Transl Neurol 2017; 4:877-887. [PMID: 29296616 PMCID: PMC5740257 DOI: 10.1002/acn3.494] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate if short-term treatment with everolimus was safe and could improve neurocognition and behavior in children with TSC. Methods This was a prospective, double-blind randomized, placebo-controlled two-center phase II study. Participants diagnosed with TSC and age 6-21 years were treated with 4.5 mg/m2 per day of oral everolimus (n = 32) or matching placebo (n = 15) taken once daily for 6 months. For efficacy, a comprehensive neurocognitive and behavioral evaluation battery was performed at baseline, 3 months, and 6 months. For safety, adverse events recorded continuously via patient diary were categorized and graded per NCI Common Toxicity Criteria for Adverse Events, version 3.0 (CTCAE 3.0). Analyses were performed on the intention-to-treat population (n = 47). Results Nearly all assessment measures failed to demonstrate significant differences between the two groups at the end of 6 months. Only one measure each of executive function (Cambridge Neuropsychological Test Automated Battery Stockings of Cambridge) favoring placebo (P = 0.025) and social cognition (Social Responsiveness Scale Social Cognition Subscale) favoring everolimus (P = 0.011) was observed. A total of 473 adverse events (AE) were reported. The average number of total AE per subject was similar for both placebo and everolimus. Most were mild or moderate in severity and serious AE were rare. Interpretation While safe, oral everolimus administered once daily for 6 months did not significantly improve neurocognitive functioning or behavior in children with TSC.
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Affiliation(s)
- Darcy A Krueger
- Division of Neurology Department of Pediatrics Cincinnati Children's Hospital Medical Center University of Cincinnati Cincinnati Ohio
| | - Anjali Sadhwani
- Department of Psychiatry Boston Children's Hospital and Harvard Medical School Boston Massachusetts
| | - Anna W Byars
- Division of Neurology Department of Pediatrics Cincinnati Children's Hospital Medical Center University of Cincinnati Cincinnati Ohio
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry University of Cape Town Cape Town South Africa
| | - David N Franz
- Division of Neurology Department of Pediatrics Cincinnati Children's Hospital Medical Center University of Cincinnati Cincinnati Ohio
| | - Vicky H Whittemore
- National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda Maryland
| | - Rajna Filip-Dhima
- Department of Neurology Boston Children's Hospital Harvard Medical School Boston Massachusetts
| | - Donna Murray
- Autism Speaks Boston Massachusetts.,Division of Developmental & Behavioral Pediatrics Department of Pediatrics Cincinnati Children's Hospital Medical Center University of Cincinnati Cincinnati Ohio
| | - Kush Kapur
- Department of Neurology Boston Children's Hospital Harvard Medical School Boston Massachusetts
| | - Mustafa Sahin
- Department of Neurology Boston Children's Hospital Harvard Medical School Boston Massachusetts
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23
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Capal JK, Horn PS, Murray DS, Byars AW, Bing NM, Kent B, Bucher LA, Williams ME, O’Kelley S, Pearson DA, Sahin M, Krueger DA, Mansour R, Hanson EM, Peters J, Goyal M, Walsh A, Bruns S, Filip-Dhima R, Mitchell T, Cutter G, Northrup H, Wu JY, Bebin M. Utility of the Autism Observation Scale for Infants in Early Identification of Autism in Tuberous Sclerosis Complex. Pediatr Neurol 2017; 75:80-86. [PMID: 28844798 PMCID: PMC5610103 DOI: 10.1016/j.pediatrneurol.2017.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a genetic disorder with high prevalence of associated autism spectrum disorder (ASD). Our primary objectives were to determine early predictors of autism risk to identify children with TSC in most need of early interventions. The Autism Observation Scale for Infants (AOSI) was evaluated as a measure of ASD-associated behaviors in infants with TSC at age 12 months and its ability to predict ASD at 24 months. METHODS Children ages 0 to 36 months with TSC were enrolled in the TSC Autism Center of Excellence Research Network (TACERN), a multicenter, prospective observational study to identify biomarkers of ASD. The AOSI was administered at age 12 months and the Autism Diagnostic Observation Schedule-2 (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R) at 24 months. Developmental functioning was assessed using the Mullen Scales of Early Learning. Children were classified as ASD or non-ASD according to the ADOS-2. RESULTS Analysis included 79 children who had been administered the AOSI at 12 months and ADOS-2 and ADI-R at 24 months. The ASD group had a mean AOSI total score at 12 months significantly higher than the non-ASD group (11.8 ± 7.4 vs 6.3 ± 4.7; P < 0.001). An AOSI total score cutoff of 13 provided a specificity of 0.89 to detect ASD with the ADOS-2. AOSI total score at 12 months was similarly associated with exceeding cutoff scores on the ADI-R. CONCLUSIONS The AOSI is a useful clinical tool in determining which infants with TSC are at increased risk for developing ASD.
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Affiliation(s)
- Jamie K Capal
- Department of Neurology MLC 2015, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Paul S. Horn
- Department of Neurology MLC 2015, Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Donna S. Murray
- Department of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, 3430 Burnet Avenue, Cincinnati, OH, 45229, USA,Autism Speaks Inc, 85 Devonshire St, Boston, MA 02109, USA
| | - Anna Weber Byars
- Department of Neurology MLC 2015, Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Nicole M. Bing
- Department of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, 3430 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Bridget Kent
- Department of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, 3430 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Lindsey A. Bucher
- Department of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, 3430 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Marian E. Williams
- Keck School of Medicine of USC, University of Southern California, Children’s Hospital Los Angeles, 4650 Sunset Blvd., MS#53, Los Angeles, CA 90027, USA
| | - Sarah O’Kelley
- University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35233, USA
| | - Deborah A. Pearson
- McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Rm. 3.126 BBSB; Houston, TX 77054
| | - Mustafa Sahin
- Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Darcy A. Krueger
- Department of Neurology MLC 2015, Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Rosleen Mansour
- McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Rm. 3.126 BBSB; Houston, TX 77054
| | - Ellen M. Hanson
- Division of Developmental Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, 300 Longwood Avenue, 02115, USA
| | - Jurriaan Peters
- Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Monisha Goyal
- University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35233, USA
| | - Amy Walsh
- Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Stephanie Bruns
- Department of Neurology MLC 2015, Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Rajna Filip-Dhima
- Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Terry Mitchell
- Department of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, 3430 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Gary Cutter
- McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Rm. 3.126 BBSB; Houston, TX 77054
| | - Hope Northrup
- McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Joyce Y. Wu
- Division of Pediatric Neurology, UCLA Mattel Children’s Hospital, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Martina Bebin
- University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35233, USA
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24
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Gipson TT, Johnston MV. New insights into the pathogenesis and prevention of tuberous sclerosis-associated neuropsychiatric disorders (TAND). F1000Res 2017; 6. [PMID: 28663780 PMCID: PMC5473405 DOI: 10.12688/f1000research.11110.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 01/13/2023] Open
Abstract
Tuberous sclerosis complex (TSC) is a multi-system disorder resulting from mutations in either the TSC1 or TSC2 genes leading to hyperactivation of mechanistic target of rapamycin (mTOR) signaling. TSC is commonly associated with autism (61%), intellectual disability (45%), and behavioral, psychiatric, intellectual, academic, neuropsychological, and psychosocial difficulties that are collectively referred to as TSC-associated neuropsychiatric disorders (TAND). More than 90% of children with TSC have epilepsy, including infantile spasms, and early onset of seizures, especially infantile spasms, is associated with greater impairment in intellectual development compared with individuals with TSC without seizures. Development of the mTOR inhibitors everolimus and sirolimus has led to considerable progress in the treatment of renal angiomyolipomata, pulmonary lymphangioleiomyomatosis, and subependymal giant cell astrocytomas in the brain. However, similar therapeutic progress is needed in the treatment of TAND.
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Affiliation(s)
- Tanjala T Gipson
- Boling Center for Developmental Disabilities, LeBonheur Children's Hospital, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Michael V Johnston
- Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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Influence of seizures on early development in tuberous sclerosis complex. Epilepsy Behav 2017; 70:245-252. [PMID: 28457992 PMCID: PMC5497719 DOI: 10.1016/j.yebeh.2017.02.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/04/2017] [Accepted: 02/04/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Epilepsy is commonly seen in Tuberous Sclerosis Complex (TSC). The relationship between seizures and developmental outcomes has been reported, but few studies have examined this relationship in a prospective, longitudinal manner. The objective of the study was to evaluate the relationship between seizures and early development in TSC. METHODS Analysis of 130 patients ages 0-36months with TSC participating in the TSC Autism Center of Excellence Network, a large multicenter, prospective observational study evaluating biomarkers predictive of autism spectrum disorder (ASD), was performed. Infants were evaluated longitudinally with standardized evaluations, including cognitive, adaptive, and autism-specific measures. Seizure history was collected continuously throughout, including seizure type and frequency. RESULTS Data were analyzed at 6, 12, 18, and 24months of age. Patients without a history of seizures performed better on all developmental assessments at all time points compared to patients with a history of seizures and exhibited normal development at 24months. Patients with a history of seizures not only performed worse, but developmental progress lagged behind the group without seizures. All patients with a history of infantile spasms performed worse on all developmental assessments at 12, 18, and 24months. Higher seizure frequency correlated with poorer outcomes on developmental testing at all time points, but particularly at 12months and beyond. Patients with higher seizure frequency during infancy continued to perform worse developmentally through 24months. A logistic model looking at the individual impact of infantile spasms, seizure frequency, and age of seizure onset as predictors of developmental delay revealed that age of seizure onset was the most important factor in determining developmental outcome. CONCLUSIONS Results of this study further define the relationship between seizures and developmental outcomes in young children with TSC. Early seizure onset in infants with TSC negatively impacts very early neurodevelopment, which persists through 24months of age.
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26
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Fosi T, Werner K, Boyd SG, De Haan M, Scott RC, Neville BG. Auditory processing following infantile spasms: An event-related potential study. Epilepsia 2017; 58:872-881. [DOI: 10.1111/epi.13725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Tangunu Fosi
- Young Epilepsy; Surrey United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
- Neurosciences Unit; UCL Institute of Child Health; London United Kingdom
| | - Klaus Werner
- Young Epilepsy; Surrey United Kingdom
- Neurosciences Unit; UCL Institute of Child Health; London United Kingdom
| | - Stewart G. Boyd
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
- Neurosciences Unit; UCL Institute of Child Health; London United Kingdom
| | - Michelle De Haan
- Centre for Developmental Cognitive Neurosciences; UCL Institute of Child Health; London United Kingdom
| | - Rod C. Scott
- Young Epilepsy; Surrey United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
- Neurosciences Unit; UCL Institute of Child Health; London United Kingdom
- Department of Neurological Sciences; University of Vermont; Burlington Vermont U.S.A
| | - Brian G. Neville
- Young Epilepsy; Surrey United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
- Neurosciences Unit; UCL Institute of Child Health; London United Kingdom
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27
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Hsieh DT, Whiteway SL, Rohena LO, Thiele EA. Tuberous sclerosis complex: Five new things. Neurol Clin Pract 2016; 6:339-347. [PMID: 29443126 DOI: 10.1212/cpj.0000000000000260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose of review Tuberous sclerosis complex (TSC) is a variably expressed neurocutaneous genetic disorder characterized by hamartomatous growths in multiple organ systems. Neurologic involvement often confers the most severe symptoms, and can include epilepsy, increased intracranial pressure from hydrocephalus, intellectual deficits, and autism. The purpose of this review is to provide a neurologically focused update in the diagnosis and treatment of these complications in patients with TSC. Recent findings We highlight 5 new areas of understanding in TSC: the neurobiology of TSC and its translation into clinical practice, vigabatrin in the treatment of infantile spasms, the role of tubers and epilepsy surgery, the treatment of subependymal giant cell astrocytomas, and TSC-related neuropsychiatric disorders. Summary These recent advances in diagnosis and treatment give our patients with TSC and their families hope for the future for improved care and possible preventive cures, to the end goal of improving quality of life.
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Affiliation(s)
- David T Hsieh
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
| | - Susan L Whiteway
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
| | - Luis O Rohena
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
| | - Elizabeth A Thiele
- Divisions of Child Neurology (DTH), Hematology/Oncology (SLW), and Medical Genetics (LOR), Department of Pediatrics, San Antonio Military Medical Center, JBSA - Ft. Sam Houston, TX; and Pediatric Epilepsy Program (EAT), Department of Neurology, Massachusetts General Hospital, Boston
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28
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Tye C, Varcin K, Bolton P, Jeste SS. Early developmental pathways to autism spectrum disorder in tuberous sclerosis complex. ADVANCES IN AUTISM 2016. [DOI: 10.1108/aia-01-2016-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Tuberous sclerosis complex (TSC) is a genetic disorder with a high prevalence of autism spectrum disorder (ASD), yet no single genetic, neurological or neurophysiological risk marker is necessary or sufficient to increase risk for ASD. This paper aims to discuss the utility of adopting a developmental perspective.
Design/methodology/approach
– The increasing number of TSC infants presenting with abnormalities prenatally provides a unique opportunity to study risk pathways to ASD from birth. Here, the authors review findings to date that support the investigation of infants with TSC to further our understanding of typical and atypical development.
Findings
– Evidence has accumulated from studies of infants at familial risk for ASD (“baby siblings”) to suggest that early markers of ASD are present in the first year of life. The early waves of prospective studies of infants with TSC indicate dynamic changes in developmental trajectories to ASD and are likely to provide insight into cascading effects of brain “insult” early in development. Emerging evidence of phenotypic and biological homology between syndromic and idiopathic cases of ASD supports the notion of a convergence of risk factors on a final common pathway in ASD.
Originality/value
– The delineation of brain-based biomarkers of risk, prediction and treatment response in TSC will be critical in aiding the development of targeted intervention and prevention strategies for those infants at high risk of poorer developmental outcomes.
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29
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Howell KB, Harvey AS, Archer JS. Epileptic encephalopathy: Use and misuse of a clinically and conceptually important concept. Epilepsia 2016; 57:343-7. [DOI: 10.1111/epi.13306] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Katherine B. Howell
- Department of Neurology; The Royal Children's Hospital; Parkville Victoria Australia
- Department of Paediatrics; The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children Research Institute; Parkville Victoria Australia
| | - A. Simon Harvey
- Department of Neurology; The Royal Children's Hospital; Parkville Victoria Australia
- Department of Paediatrics; The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children Research Institute; Parkville Victoria Australia
| | - John S. Archer
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- The Florey Institute of Neuroscience and Mental Health; Parkville Victoria Australia
- Austin Health; Melbourne Victoria Australia
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30
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Gipson TT, Poretti A, Thomas EA, Jenkins KT, Desai S, Johnston MV. Autism Phenotypes in Tuberous Sclerosis Complex: Diagnostic and Treatment Considerations. J Child Neurol 2015; 30:1871-6. [PMID: 26303410 DOI: 10.1177/0883073815600871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 12/19/2022]
Abstract
Tuberous sclerosis complex is a multisystem, chronic genetic condition characterized by systemic growth of benign tumors and often accompanied by epilepsy, autism spectrum disorders, and intellectual disability. Nonetheless, the neurodevelopmental phenotype of these patients is not often detailed. The authors describe 3 individuals with tuberous sclerosis complex who share common characteristics that can help to identify a distinct profile of autism spectrum disorder. These findings include typical cognitive development, expressive and pragmatic language deficits, and anxiety. The authors also describe features specific to tuberous sclerosis complex that require consideration before diagnosing an autism spectrum disorder. Identifying distinct profiles of autism spectrum disorder in tuberous sclerosis complex can help optimize treatment across the life span.
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Affiliation(s)
- Tanjala T Gipson
- Tuberous Sclerosis Center of Excellence, Kennedy Krieger Institute, Baltimore, MD, USA Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA The Clinical Trials Unit, Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily A Thomas
- Tuberous Sclerosis Center of Excellence, Kennedy Krieger Institute, Baltimore, MD, USA Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Kosunique T Jenkins
- Tuberous Sclerosis Center of Excellence, Kennedy Krieger Institute, Baltimore, MD, USA Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Sonal Desai
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Michael V Johnston
- Tuberous Sclerosis Center of Excellence, Kennedy Krieger Institute, Baltimore, MD, USA Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA The Clinical Trials Unit, Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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31
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Bolton PF, Clifford M, Tye C, Maclean C, Humphrey A, le Maréchal K, Higgins JNP, Neville BGR, Rijsdjik F, Yates JRW. Intellectual abilities in tuberous sclerosis complex: risk factors and correlates from the Tuberous Sclerosis 2000 Study. Psychol Med 2015; 45:2321-2331. [PMID: 25827976 DOI: 10.1017/s0033291715000264] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is associated with intellectual disability, but the risk pathways are poorly understood. METHOD The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of the natural history of TSC. One hundred and twenty-five UK children age 0-16 years with TSC and born between January 2001 and December 2006 were studied. Intelligence was assessed using standardized measures at ≥2 years of age. The age of onset of epilepsy, the type of seizure disorder, the frequency and duration of seizures, as well as the response to treatment was assessed at interview and by review of medical records. The severity of epilepsy in the early years was estimated using the E-Chess score. Genetic studies identified the mutations and the number of cortical tubers was determined from brain scans. RESULTS TSC2 mutations were associated with significantly higher cortical tuber count than TSC1 mutations. The extent of brain involvement, as indexed by cortical tuber count, was associated with an earlier age of onset and severity of epilepsy. In turn, the severity of epilepsy was strongly associated with the degree of intellectual impairment. Structural equation modelling supported a causal pathway from genetic abnormality to cortical tuber count to epilepsy severity to intellectual outcome. Infantile spasms and status epilepticus were important contributors to seizure severity. CONCLUSIONS The findings support the proposition that severe, early onset epilepsy may impair intellectual development in TSC and highlight the potential importance of early, prompt and effective treatment or prevention of epilepsy in tuberous sclerosis.
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Affiliation(s)
- P F Bolton
- MRC Centre for Social Genetic & Developmental Psychiatry & Department of Child Psychiatry,The Institute of Psychiatry,Kings College London,London,UK
| | - M Clifford
- MRC Centre for Social Genetic & Developmental Psychiatry & Department of Child Psychiatry,The Institute of Psychiatry,Kings College London,London,UK
| | - C Tye
- MRC Centre for Social Genetic & Developmental Psychiatry & Department of Child Psychiatry,The Institute of Psychiatry,Kings College London,London,UK
| | - C Maclean
- Department of Medical Genetics,University of Cambridge,Cambridge,UK
| | - A Humphrey
- Section of Developmental Psychiatry,University of Cambridge,Cambridge,UK
| | - K le Maréchal
- MRC Centre for Social Genetic & Developmental Psychiatry & Department of Child Psychiatry,The Institute of Psychiatry,Kings College London,London,UK
| | - J N P Higgins
- Department of Radiology,Addenbrooke's Hospital,Cambridge,UK
| | - B G R Neville
- Institute of Child Health,University College London UK and National Centre for Young People with Epilepsy,Lingfield,UK
| | - F Rijsdjik
- MRC Centre for Social Genetic & Developmental Psychiatry & Department of Child Psychiatry,The Institute of Psychiatry,Kings College London,London,UK
| | - J R W Yates
- Department of Medical Genetics,University of Cambridge,Cambridge,UK
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Long-Term Everolimus Treatment in Individuals With Tuberous Sclerosis Complex: A Review of the Current Literature. Pediatr Neurol 2015; 53:23-30. [PMID: 26092412 DOI: 10.1016/j.pediatrneurol.2014.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/02/2014] [Accepted: 10/26/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tuberous sclerosis complex is a genetic disease usually caused by mutations to either TSC1 or TSC2, where its gene products are involved in the inhibition of the mammalian target of rapamycin pathway. Under normal cellular conditions, mammalian target of rapamycin (mTOR) regulates cell growth and proliferation in response to signals from nutrients or growth factors, but loss of TSC1 or TSC2 leads to overactivation of mTOR and uncontrolled cellular proliferation. Everolimus is an mTOR inhibitor approved for use in a number of indications where mTOR overactivation is implicated, including tuberous sclerosis complex. METHODS AND PATIENTS We conducted a literature search of PubMed to identify published articles about the long-term efficacy and safety of everolimus in patients with tuberous sclerosis complex. RESULTS The short-term efficacy and safety of everolimus in patients with tuberous sclerosis complex has been demonstrated in placebo-controlled trials, and open-label extension studies are ongoing to monitor long-term effects, including safety. Examples of regrowth following discontinuation of mTOR inhibitors suggest that everolimus needs to be given indefinitely to maintain suppression of subependymal giant cell astrocytoma and other tuberous sclerosis complex-associated disease manifestations. No additional safety concerns have been reported to date with long-term administration of everolimus, but published long-term data (>1 year treatment) are currently limited to a small open-label trial and case reports for this relatively rare condition. CONCLUSIONS From the limited data available, long-term administration of everolimus appears feasible with few safety concerns beyond those associated with short-term use. Further investigation is needed to determine the long-term efficacy and safety of everolimus in patients with tuberous sclerosis complex.
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Overwater IE, Bindels-de Heus K, Rietman AB, ten Hoopen LW, Vergouwe Y, Moll HA, de Wit MCY. Epilepsy in children with tuberous sclerosis complex: Chance of remission and response to antiepileptic drugs. Epilepsia 2015; 56:1239-45. [DOI: 10.1111/epi.13050] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Iris E. Overwater
- Department of Neurology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Karen Bindels-de Heus
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Pediatrics; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - André B. Rietman
- Department of Neurology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Leontine W. ten Hoopen
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Yvonne Vergouwe
- Department of Public Health; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | - Henriette A. Moll
- Department of Pediatrics; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - Marie-Claire Y. de Wit
- Department of Neurology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
- ENCORE TSC Expertise Center; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
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Role of mTOR inhibitors in epilepsy treatment. Pharmacol Rep 2015; 67:636-46. [DOI: 10.1016/j.pharep.2014.12.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/24/2014] [Accepted: 12/30/2014] [Indexed: 01/16/2023]
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Werner K, Fosi T, Boyd SG, Baldeweg T, Scott RC, Neville BG. Temporal lobe impairment in West syndrome: event-related potential evidence. Ann Neurol 2014; 77:47-57. [PMID: 25363285 PMCID: PMC4305199 DOI: 10.1002/ana.24297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 10/14/2014] [Accepted: 10/26/2014] [Indexed: 11/26/2022]
Abstract
Objective This study investigates auditory processing in infants with West syndrome (WS) using event-related potentials (ERPs). Methods ERPs were measured in 25 infants with mainly symptomatic WS (age range = 3–10 months) and 26 healthy term infants (age range = 3–9 months) using an auditory novelty oddball paradigm. The ERP recordings were made during wakefulness and repeated in stage II sleep. Results The obligatory components (P150, N250, P350) and novelty response components (P300, Nc) were recordable during both sleep and wakefulness in patients and controls. All ERP latencies decreased with age in controls but not in the WS group (age × group interaction, F = 22.3, p < 0.0001). These ERP latency alterations were not affected by pharmacological treatment for WS. Interpretation This study demonstrated a persistently altered ERP signature in patients with a recent history of infantile spasms. The prolongation of auditory obligatory and novelty ERPs in WS patients indicates a severe failure of temporal lobe maturation during infancy. It remains to be investigated whether this predicts long-term cognitive impairments characteristic for this epileptic encephalopathy.
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Affiliation(s)
- Klaus Werner
- Young Epilepsy, Surrey, Great Ormond Street Hospital for Children National Health Service Trust, London; Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children National Health Service Trust, London; Clinical Neurosciences, University College London Institute of Child Health, London
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Sadowski K, Jóźwiak S. Recent advances in pathophysiology studies and treatment of epilepsy in neurocutaneous disorders. JOURNAL OF EPILEPTOLOGY 2014. [DOI: 10.1515/joepi-2015-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SUMMARYIntroduction.Epilepsy that is associated with neurocutaneous disorders seriously deteriorates quality of life and cognitive outcome of affected children. Recent advances in epilepsy pathophysiology raise hopes for better treatment results in this difficult group of patients.Aim.The aim of this review is to present recent treatment recommendations as well as current research progress in the most frequent neurocutaneous disorders.Material and methods.We analyzed PubMed database to select the most prominent and recent (up to 2014 year) publications on the treatment and mechanisms of epilepsy in selected neurocutaneous disorders. We aimed to emphasize evidence-based medicine recommendations as well as basic experimental studies dealing with molecular mechanisms of epileptogenesis.Discussion and conclusions.Recent advances in disease-modifying treatment options such as mTOR inhibitors in patients with tuberous sclerosis complex open up new perspectives for neurologists. Traditional resective surgery has still a major role as a treatment of choice in carefully selected cases.
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Friedrich RE, Hagel C. Rhinophyma in tuberous sclerosis complex: case report with brief review of literature. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2014; 3:Doc12. [PMID: 26504723 PMCID: PMC4582513 DOI: 10.3205/iprs000053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tuberous sclerosis or tuberous sclerosis complex (TSC) is an autosomal dominant inherited disease characterized by the triad epilepsy, hamartomas (angiofibroma) and reduced intellectual capacity. Phenotype can vary considerably. Almost all patients with TSC have at least one characteristic dermatologic feature. Facial angiofibroma can cause severe disfigurement. It may involve the cheeks, perioral region and nose, resulting in thick layers of nodular and pustular skin. Aesthetic surgery of the face comprises an individually adapted ablation of the affected skin regions in order to improve physical appearance. Reports on the subject of surgery for nasal angiofibroma confirm the homogenous transformation of the connective tissues by this hamartoma. Hitherto there is only one report in the literature describing the typical epithelial alterations of the nasal skin compatible with a rhinophyma and adjacent angiofibroma. Here we report the successful electrosurgical treatment of a patient with TSC and extensive sebaceous glands giving rise to a rhinophyma in close association with angiofibroma.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Cranio-Maxillo-Facial Surgery, Eppendorf University Hospital, University of Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, Eppendorf University Hospital, University of Hamburg, Germany
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Gipson TT, Gerner G, Srivastava S, Poretti A, Vaurio R, Hartman A, Johnston MV. Early neurodevelopmental screening in tuberous sclerosis complex: a potential window of opportunity. Pediatr Neurol 2014; 51:398-402. [PMID: 25160545 PMCID: PMC4196722 DOI: 10.1016/j.pediatrneurol.2014.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Infants born with tuberous sclerosis complex, a genetic condition resulting from a mutation in TSC1 or TSC2, are at increased risk for intellectual disability and/or autism. Features of epilepsy, neuropathology, genetics, as well as timing and type of mechanism-based medications have been proposed as risk factors. Neurodevelopmental outcomes have been reported among these studies; however, few include data about the individuals' early neurodevelopmental profile, a factor that may contribute significantly to these outcomes. Further, there is no clinical standard for the neurodevelopmental assessment of these infants. The paucity of data regarding the natural history of neurodevelopment in infants with tuberous sclerosis complex and the lack of a gold standard for neurodevelopmental evaluation present a significant challenge for clinicians and researchers. METHOD During the first year of life, we tracked the onset of infantile spasms, the type and timing of antiepileptic treatments, and the associated response of two age-matched infants with tuberous sclerosis complex. We also employed Capute Scales as a part of a structured neurodevelopmental evaluation to characterize and compare their neurodevelopmental profiles. RESULTS Infant 1 developed infantile spasms with confirmed hypsarrhythmia at 4 months of age. Treatment with vigabatrin was initiated within 24 hours with near immediate cessation of seizures and no further seizures to date. Expressive language delay was detected at 12 months and treated with speech and/or language therapy. Infant 2 developed complex partial seizures at 1 month. Treatment included levetiracetam, oxcarbazepine, and the ketogenic diet. Vigabatrin was initiated on detection of hypsarrhythmia after 4 months. Intractable epilepsy persists to date. Global developmental delay was evident by 8 months and treated with physical, occupational, and speech and/or language therapy. CONCLUSION Many risk factors have been associated with intellectual disability and/or autism in individuals with tuberous sclerosis complex; however, few data are available regarding practical clinical tools for early identification. In our case series, inclusion of the Capute Scales as a part of routine medical care led to the identification of developmental delays in the first 12 months of life and selection of targeted neurodevelopmental interventions. Development of a risk-based assessment using this approach will be the focus of future studies as it may provide a potential window of opportunity for both research and clinical purposes. In research, it may serve as an objective outcome measure. Clinically, this type of assessment has potential for informing clinical treatment decisions and serving as a prognostic indicator of long-term cognitive and psychiatric outcomes.
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Affiliation(s)
- Tanjala T. Gipson
- Tuberous Sclerosis Clinic, Kennedy Krieger Institute, Baltimore, MD,Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD,Clinical Trials Unit, Hugo W. Moser Research Institute, Inc., Kennedy Krieger Institute, Baltimore, MD,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gwendolyn Gerner
- Tuberous Sclerosis Clinic, Kennedy Krieger Institute, Baltimore, MD,Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD,Clinical Trials Unit, Hugo W. Moser Research Institute, Inc., Kennedy Krieger Institute, Baltimore, MD
| | - Siddharth Srivastava
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca Vaurio
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Adam Hartman
- The John M. Freeman Pediatric Epilepsy Center, Department of Neurology, Johns Hopkins University School of Medicine
| | - Michael V. Johnston
- Tuberous Sclerosis Clinic, Kennedy Krieger Institute, Baltimore, MD,Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD,Clinical Trials Unit, Hugo W. Moser Research Institute, Inc., Kennedy Krieger Institute, Baltimore, MD,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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Affiliation(s)
- Cassie Karlsson
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
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