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Barzegar M, Poorshiri B, Yousefi L, Raeisi S, Bakhtiary H, Eftekhari Milani A, Ebadi Z. The clinical and paraclinical manifestations of tuberous sclerosis complex in children. Acta Neurol Belg 2022; 122:385-390. [PMID: 33738777 DOI: 10.1007/s13760-021-01635-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal-dominant, multi-system, neurocutaneous disorder characterized by hamartomas in multiple organs. This study aimed to evaluate the clinical and paraclinical manifestations of children with TSC. The clinical and paraclinical characteristics of 79 children with TSC were evaluated and the possible correlations between the factors were calculated. Among the studied children which composed of 41 females (51.9%) and 38 males (48.1%), skin manifestations as hypopigmented macules as well as the brain involvement as cortical tubers in all (100%) cases, seizure in 74 (93.7%), and sub-ependymal nodules in 73 (92.4%) patients were the most common findings. The renal angiomyolipoma was diagnosed in 36 (70.6%) out of 51 patients. Subependymal giant cell astrocytoma in 25 (3/54%) out of 46 patients, retinal hamartoma in 15 (42.9%) out of 35 patients, and cardiac rhabdomyoma in 17 (41.3%) out of 46 patients were diagnosed. Furthermore, 50 (63.3%) out of 79 patients had psychological disorders that had a significant correlation with the prevalence of seizures (p = 0.002). Given the multi-systemic involvement of TSC, it is necessary that all organs of the patients even without any related clinical symptom or sign be examined regularly for proper therapeutic intervention and prevent disease progression. The growth of hamartomas in the brain and kidneys can be life-threatening; therefore, these organs have more importance to be regularly followed up and examined.
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Affiliation(s)
- Mohammad Barzegar
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Bita Poorshiri
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Yousefi
- Medical Radiation Sciences Research Group, Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Raeisi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Bakhtiary
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Eftekhari Milani
- Department of Ophthalmology, Nikookary Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zakiyeh Ebadi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Vorobichik Berar O, Tzadok M, Zloto O, Moroz I, Hecht I, Musika AA, Shlomovitz O, Fabian ID, Vishnevskia Dai V. Mammalian target of rapamycin inhibitors for the treatment of astrocytic hamartoma in tuberous sclerosis complex (TSC). Graefes Arch Clin Exp Ophthalmol 2022; 260:3061-3068. [PMID: 35230473 DOI: 10.1007/s00417-022-05585-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disorder. Fifty percent of patients with TSC will develop retinal astrocytic hamartoma (RAH). The mammalian target of rapamycin (mTOR) inhibitors interferes with the pathological mechanisms of TSC. Treatment of RAH with mTOR inhibitors has been described in only a few isolated case reports. The purpose of this study was to assess the effect of mTOR inhibitors on RAH in a small cohort of patients. METHODS The medical records of all consecutive patients with ocular manifestations of TSC that were treated with mTOR inhibitors at the Sheba Medical Center from January 2014 to December 2018 were retrospectively reviewed. Data collection included demographics, medical history, ocular presentation, ocular treatment, and treatment outcome. Tumor size was assessed by a masked observer, before and after treatment. Lesion measurements were made with Heidelberg SD-OCT (HRA + OCT SPECTRALIS), and fundus photos were taken with RetCam3® (Natus, USA) and analyzed by "ImageJ" software. RESULTS Eleven patients with tuberous sclerosis and astrocytic hamartoma were treated with mTOR inhibitors in the study period. Of them, 6 children (11 eyes, 20 tumors) had proper imaging of tumor size before and after treatment. The analysis included these 11 eyes. All six patients had non-ocular manifestations of TSC, including dermatologic (n = 5), neurologic (n = 5), and renal (n = 3) involvement. Ocular involvement included in five eyes (45%) tumors near the optic disc and in four eyes (37%) foveal tumors. The mean follow-up duration was 2.15 ± 1.4 years (range 10 months to 4.5 years). The average tumor base reduction in the treated group was 17.8% ± 15.9. The average maximal thickness at baseline was 414 ± 174 μm (range 152-686 μm). There was a 14% ± 7.1 reduction after treatment. None of the tumors showed evidence of growth at the final follow-up. CONCLUSION The findings of this study suggest that mTOR inhibitors can reduce tumor size and that they can be considered as an optional treatment in certain conditions. This preliminary report is the first to quantitatively assess pre- and posttreatment tumor size, in young patients.
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Affiliation(s)
- Ofri Vorobichik Berar
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Tzadok
- Pediatric Neurology Unit, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Moroz
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel
| | - Anne Ampaire Musika
- Department of Ophthalmology, College of Health Science, Makerere University, Kampala, Uganda
| | - Omer Shlomovitz
- Pediatric Neurology Unit, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido-Didi Fabian
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vicktoria Vishnevskia Dai
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Bakhtiary H, Barzegar M, Shiva S, Poorshiri B, Hajalioghli P, Herizchi Ghadim H. The Effect of Everolimus on Subependymal Giant Cell Astrocytoma (SEGA) in Children with Tuberous Sclerosis Complex. IRANIAN JOURNAL OF CHILD NEUROLOGY 2021; 15:15-25. [PMID: 34782838 PMCID: PMC8570625 DOI: 10.22037/ijcn.v15i4.30591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/15/2020] [Indexed: 02/03/2023]
Abstract
Objective Subependymal Giant Cell Astrocytomas (SEGAs) are slow-growing glioneuronal tumors typically found around the ventricles of the brain, particularly near the foramen of Monro in 15%-20% of patients with tuberous sclerosis complex (TSC). Surgical resection is the standard treatment for these symptomatic tumors. The mTOR inhibitor everolimus can be regarded as an alternative treatment for SEGAs due to the complications of surgery. The present study primarily aimed to specify the effect of everolimus on SEGA volume change before and after treatment. The secondary objective was to determine the effect of this drug on renal angiomyolipoma (AML), skin lesions, and seizures in TSC patients. Materials & Methods This pre- and post-treatment clinical trial was performed on 14 children (eight females and six males with a mean age of 10 years) previously diagnosed with TSC based on the diagnostic criteria. The subjects received oral everolimus at a dose of 3 mg/m2 for at least six months. Results Half of the patients had more than 30% of volume loss in SEGA, and in 28.5% of them, a ≥ 50% reduction in SEGA volume was observed (P=0.01). Moreover, 92.9% of the patients had a ≥ 50% decrease in the frequency of seizures (P=0.000). The response rate in AML and skin lesions was 14.2% and 50%, respectively. Conclusion Everolimus significantly reduced the seizure frequency and SEGA volume in the subjects; hence, it can be used as a potential alternative treatment for symptomatic SEGA in TSC patients.
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Affiliation(s)
- Hassan Bakhtiary
- Pediatric Health Research Center, Tabriz University of Medical Science, Tabriz , Iran
| | - Mohammad Barzegar
- Pediatric Health Research Center, Tabriz University of Medical Science, Tabriz , Iran
| | - Shadi Shiva
- Pediatric Health Research Center, Tabriz University of Medical Science, Tabriz , Iran
| | - Bita Poorshiri
- Pediatric Health Research Center, Tabriz University of Medical Science, Tabriz , Iran
| | - Parisa Hajalioghli
- Department of Radiology , Tabriz University of Medical Science, Tabriz , Iran
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Abstract
Phakomatoses present with characteristic findings on the skin, central or peripheral nervous system, and tumors. Neurofibromatosis type 1 is the most common syndrome and is characterized by Café-au-lait macules, intertriginous freckling, Lisch nodules, and tumors including neurofibromas, malignant peripheral nerve sheath tumors, and gliomas. Tuberous Sclerosis Complex is characterized by benign hamartomas presenting with hypomelanotic macules, shagreen patches, angiofibromas, confetti lesions and tumors including cortical tubers, subependymal nodules, subependymal giant cell astrocytomas and tumors of the kidney, lung, and heart. Managing these disorders requires disease specific supportive care, tumor monitoring, surveillance for selected cancers, and treatment of comorbid conditions.
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Affiliation(s)
- Benjamin Becker
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Roy E Strowd
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA; Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health, Winston Salem, NC 27157, USA; Translational Science Institute, Wake Forest Baptist Health, Winston Salem, NC 27157, USA
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Shapira Rootman M, Goldberg Y, Cohen R, Kropach N, Keidar I, Friedland R, Dotan G, Konen O, Toledano H. The great mimicker: Phenotypic overlap between constitutional mismatch repair deficiency and Tuberous Sclerosis complex. Clin Genet 2019; 97:296-304. [DOI: 10.1111/cge.13656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/24/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Mika Shapira Rootman
- Department of RadiologySchneider Children's Medical Center of Israel Petach Tikva Israel
- The Sackler faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Yael Goldberg
- The Raphael Recanati Genetic instituteRabin Medical Center Petach Tikva Israel
- The Sackler faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Rony Cohen
- Neurology and epilepsy centerSchneider Children's Medical Center of Israel Petach Tikva Israel
- The Sackler faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Nesia Kropach
- The Genetics unitSchneider Children's Medical Center of Israel Petach Tikva Israel
- The Department of Pediatrics "B"Schneider Children's Medical Center of Israel Petach Tikva Israel
- The Sackler faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Inbal Keidar
- The Raphael Recanati Genetic instituteRabin Medical Center Petach Tikva Israel
| | - Rivka Friedland
- The Dermatology UnitSchneider Children's Medical Center of Israel Petach Tikva Israel
- The Sackler faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Gad Dotan
- The Wohl Ophthalmology and Blindness Prevention unitSchneider Children's Medical Center of Israel Petach Tikva Israel
- The Sackler faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Osnat Konen
- Department of RadiologySchneider Children's Medical Center of Israel Petach Tikva Israel
- The Sackler faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Helen Toledano
- The Rina Zaizov Hematology‐Oncology DivisionSchneider Children's Medical Center of Israel Petach Tikva Israel
- The Sackler faculty of MedicineTel Aviv University Tel Aviv Israel
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Ariceta G, Buj MJ, Furlano M, Martínez V, Matamala A, Morales M, Robles NR, Sans L, Villacampa F, Torra R. Recommendations for the management of renal involvement in the tuberous sclerosis complex. Nefrologia 2019; 40:142-151. [PMID: 31722796 DOI: 10.1016/j.nefro.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/04/2019] [Accepted: 07/15/2019] [Indexed: 12/01/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare, hereditary, multisystemic disease with a broad phenotypic spectrum. Its management requires the collaboration of multiple specialists. Just as in the paediatric age, the paediatric neurologist takes on special importance; in adulthood, renal involvement is the cause of the greatest morbidity and mortality. There are several recommendations on the general management of patients with TSC but none that focuses on renal involvement. These recommendations respond to the need to provide guidelines to facilitate a better knowledge and diagnostic-therapeutic management of the renal involvement of TSC through a rational use of complementary tests and the correct use of available treatments. Their elaboration has been based on consensus within the hereditary renal diseases working group of the SEN/REDINREN (Spanish Society of Nephrology/Kidney Research Network). It has also counted on the participation of non-nephrologist specialists in TSC in order to expand the vision of the disease.
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Affiliation(s)
- Gema Ariceta
- Servicio de Nefrología Pediátrica, Hospital Valle Hebrón, REDINREN, Barcelona, España
| | - María José Buj
- Servicio de Radiología, Hospital 12 de Octubre, Madrid, España
| | - Mónica Furlano
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autónoma de Barcelona, REDINREN, Barcelona, España
| | - Víctor Martínez
- Servicio de Nefrología, Hospital Virgen de la Arrixaca, Murcia, España
| | - Anna Matamala
- Departamento de Enfermería, Fundació Puigvert, Barcelona, España
| | | | | | - Laia Sans
- Servicio de Nefrología, Hospital del Mar, REDINREN, Barcelona, España
| | - Felipe Villacampa
- Servicio de Urología, Clínica Universidad de Navarra, Madrid, España
| | - Roser Torra
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, IIB Sant Pau, Universitat Autónoma de Barcelona, REDINREN, Barcelona, España.
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Bautista Alonso RE, Artajona Rodrigo E, Povar Echeverría M. Tuberous sclerosis complex in a third level hospital: Need for integral management. Med Clin (Barc) 2018; 153:338-339. [PMID: 30322651 DOI: 10.1016/j.medcli.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/19/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022]
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Portocarrero LKL, Quental KN, Samorano LP, de Oliveira ZNP, Rivitti-Machado MCDM. Tuberous sclerosis complex: review based on new diagnostic criteria. An Bras Dermatol 2018; 93:323-331. [PMID: 29924239 PMCID: PMC6001077 DOI: 10.1590/abd1806-4841.20186972] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/18/2017] [Indexed: 02/07/2023] Open
Abstract
Tuberous sclerosis complex is a multisystemic, autosomal dominant genetic disorder with complete penetrance, that can evolve with hamartomas in multiple organs, such as skin, central nervous system, kidney and lung. Due to the wide phenotypic variability, the disease is often not recognized. Tuberous sclerosis complex affects one in 10,000 newborns and most patients are diagnosed during the first 15 months of life. The diagnostic criteria for tuberous sclerosis were reviewed in 2012, at the second International Tuberous Sclerosis Complex Consensus Conference. The diagnosis is based on genetic criteria, by the identification of inactivating pathogenic mutation of tumor suppressor genes TSC1 and TSC2, and clinical criteria, including cutaneous, renal, pulmonary, cardiac and neurological manifestations. The treatment of tuberous sclerosis complex consists, mainly, in management of the symptoms caused by hamartomas and in prevention of organ failure. Multidisciplinary approach is recommended, in order to obtain better clinical outcomes.
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Affiliation(s)
- Larissa Karine Leite Portocarrero
- Outpatient Clinic of Pediatric Dermatology, Hospital das
Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP),
São Paulo (SP), Brazil
| | - Klícia Novais Quental
- Outpatient Clinic of Pediatric Dermatology, Hospital das
Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP),
São Paulo (SP), Brazil
| | - Luciana Paula Samorano
- Department of Dermatology, Hospital das Clínicas, Faculdade
de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo (SP),
Brazil
| | - Zilda Najjar Prado de Oliveira
- Department of Dermatology, Hospital das Clínicas, Faculdade
de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo (SP),
Brazil
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Emir S, Hacısalihoğlu Ş, Özyörük D, Ekici F, Değerliyurt A, Güven A, Çetin İ. Assessment of tumors in children with tuberous sclerosis: a single centre's experience. Turk Arch Pediatr 2017; 52:30-34. [PMID: 28439198 DOI: 10.5152/turkpediatriars.2017.4309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/02/2016] [Indexed: 11/22/2022]
Abstract
AIM As a result of mutations in TSC1 (9q34) and TSC2 (16p13.3) tumor supressor genes, the mammalian target of the rapamycin (mTor) signaling pathway is overactivated in patients with tuberous sclerosis. Abnormal cell proliferation and differentiation is responsible for the growth several different tumors. The aim of this study was to review tumors in our patients with tuberous sclerosis. MATERIAL AND METHODS Thirty-six patients with tuberous sclerosis were reviewed retrospectively in terms of age, sex, family history, clinical findings, presence of tumors, and treatments. RESULTS Our study included 36 patients (18/18:M/F) aged between two days and 17 years with a median age of 6 years. There were hypopigmented spots in 30 patients, seizures in 28 patients, and a family history in 11 patients. Tumors related to tuberous sclerosis were renal angiomyolipomas in 21 patients, cardiac rhabdomyomas in 11, subependymal giant cell astrocytomas in seven, and non renal hamartoma in one patient. Everolimus treatment was used in only two patients because of hemodynamic instability. CONCLUSIONS Tuberous sclerosis is a multisystemic disease characterized by the presence of various benign tumors and neurologic disorders. Renal angiomyolipomas, cardiac rhabdomyomas, and subependymal giant cell astrocytomas are commonly observed in patients with tuberous sclerosis. mTOR inhibitors such as everolimus and sirolimus have been increasingly used in the treatment of these tumors. However, the duration and optimal dose of mTOR inhibitors is still controversial and should be used in selected cases.
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Affiliation(s)
- Suna Emir
- Clinic of Pediatric Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Şadan Hacısalihoğlu
- Clinic of Pediatric Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Derya Özyörük
- Clinic of Pediatric Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Filiz Ekici
- Clinic of Pediatric Cardiology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Aydan Değerliyurt
- Clinic of Pediatric Neurology, Ankara Children's Hematology and Oncology Education and Research hospital, Ankara, Turkey
| | - Alev Güven
- Clinic of Pediatric Neurology, Ankara Children's Hematology and Oncology Education and Research hospital, Ankara, Turkey
| | - İlker Çetin
- Clinic of Pediatric Cardiology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
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