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Sauter M, Weber L, Jung D, Weremko M, Bachmann D, Fischereder M, Bachmann HS. Patients' and physicians' awareness of clinical symptoms and disease severity in tuberous sclerosis complex. Orphanet J Rare Dis 2024; 19:106. [PMID: 38459571 PMCID: PMC10921799 DOI: 10.1186/s13023-024-03118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/03/2024] [Indexed: 03/10/2024] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare inherited disease with the potential to affect virtually every organ system. Clinical presentation is age- and partly sex-dependent and varies broadly with respect to disease manifestations including treatment-refractory epilepsy, intellectual disability and TSC-associated neuropsychiatric disorders, chronic kidney disease or progressive lung function decline. Given the complexity of this disease, multidisciplinary care in specialized TSC centres is recommended. We aimed to elucidate the state of knowledge of patients/caregivers and physicians on individual disease manifestations. We further examined whether the association to a TSC centre has an impact on the comprehensive consideration of potential disease manifestations. Therefore, a survey was performed in a cohort of German TSC patients and their physicians. Complete information was available for 94 patients with a median age of 18 years [range 1-55] and a sex distribution of 53.2% (male): 48.8% (female). Using almost identical questionnaires for patients/caregivers and their respective physician, there was a good correlation for disease assessments associated with relevant morbidity and mortality like epilepsy, renal angiomyolipoma, cardiac rhabdomyomas or intellectual disability. Correlation was moderate for several neuropsychiatric disorders and only poor for hypomelanotic macules, dental pits or retinal achromic patches. Estimation of overall disease severity using a numeric rating scale correlated highly significantly (Pearson correlation coefficient = 0.767; p < 0.001) between patients/caregivers and physicians. In general, physicians more likely quoted items as 'unknown' than patients (822 answers vs. 435 answers in the respective groups). Questionnaires completed by physicians who were associated with a specialized TSC centre declared a significantly lower proportion of items as unknown (mean 8.7% vs. 20.5%; p < 0.001). These findings indicate that patients treated by specialized TSC centres seem to obtain a more comprehensive surveillance. Furthermore, it shows that there were reasonable surveillance strategies in general and sufficient patient/caregiver interaction and education in the examined cohort. However, for the most prominent disease characteristics there was a good awareness within both the patients/caregivers and the physicians group.
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Affiliation(s)
- Matthias Sauter
- Klinikverbund Allgäu, Robert-Weixler-Str. 50, 87439, Kempten, Germany
| | - Lea Weber
- Institute of Pharmacology and Toxicology, Centre for Biomedical Education and Research (ZBAF), School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Dominik Jung
- Institute of Pharmacology and Toxicology, Centre for Biomedical Education and Research (ZBAF), School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Michael Weremko
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dorothea Bachmann
- Institute of Pharmacology and Toxicology, Centre for Biomedical Education and Research (ZBAF), School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Michael Fischereder
- Tuberöse Sklerose Zentrum, Klinikum Der Universität München, Ziemssenstr. 5, 80336, Munich, Germany
| | - Hagen Sjard Bachmann
- Institute of Pharmacology and Toxicology, Centre for Biomedical Education and Research (ZBAF), School of Medicine, Witten/Herdecke University, Witten, Germany.
- Institute of Pharmacogenetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Chabalala WT, Bojosi K, Maphane T, Olashore AA. Neuropsychiatric manifestations of tuberous sclerosis in a young man in a psychiatric hospital in Botswana: a case report. J Int Med Res 2024; 52:3000605231223450. [PMID: 38217425 PMCID: PMC10788076 DOI: 10.1177/03000605231223450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/11/2023] [Indexed: 01/15/2024] Open
Abstract
Tuberous sclerosis complex (TSC), first described in 1880, is a disorder that affects multiple systems. Its symptoms include seizures, intellectual disability, and angiofibromas. TSC is caused by mutations in the TSC1 and TSC2 genes and is inherited in an autosomal dominant manner. The present report describes the case of a patient with an unusual psychological presentation who was evaluated in a psychiatric hospital. A man with poorly managed epilepsy was brought to Botswana's only psychiatric hospital. After clinical assessment, a diagnosis of tuberous sclerosis complex was made, which was later confirmed through neuroimaging and genetic tests. Some of the patient's relatives also showed similar neuropsychiatric symptoms. Given that psychiatry may be the first medical contact for TSC patients, especially in low-resource settings, clinicians need to be knowledgeable of various neuropsychiatric conditions and be aware of the possibility of TSC in patients that present with neurocutaneous manifestations. A multidisciplinary team approach is vital for the investigation and management of such cases.
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Affiliation(s)
- Wame T. Chabalala
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Kagiso Bojosi
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Tseleng Maphane
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Anthony A. Olashore
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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Barabrah AM, Dukmak ON, Toukan AR, Dabbas FM, Emar M, Rajai A. Bilateral renal angiomyolipoma with left renal artery aneurysm in tuberous sclerosis: case report and literature review. Ann Med Surg (Lond) 2023; 85:5113-5116. [PMID: 37811090 PMCID: PMC10553073 DOI: 10.1097/ms9.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance Tuberous sclerosis disorder (TSD) is a rare genetic disease that causes abnormal growths or tumors in various organs of the body. They are usually benign and asymptomatic. However, severe, rapidly growing tuberous sclerosis can be fatal. Renal angiomyolipomas are commonly associated with TSD, which can be further worsened by the presence of aneurysms and put the patient at risk for life-threatening hemorrhage. Case presentation A 29-year-old female presented to the emergency room complaining of right flank pain with an unknown past medical history of tuberous sclerosis. The patient was suspected to have TSD as she fulfilled one of the major features of TSD required to establish a possible diagnosis. On computed tomography scan imaging, bilateral fat-density nodules were revealed in both kidneys. The largest is 7 cm in the left kidney, located at the upper pole, and was associated with a bleeding aneurysm measuring 4 cm in diameter. While the other fatty nodule was recorded at 6 cm in the right kidney at the lower pole. Clinical discussion After evaluation, the patient was planned for diagnostic catheterization of the left kidney, through which selective angiography of the left kidney was done, and eventually, selective embolization of the branch supplying the left angiomyolipoma was performed. Conclusion The authors finally conclude that thorough investigations, including systemic manifestations, must be taken into consideration when suspecting tuberous sclerosis, and a conservative approach must always be prioritized before taking any decision toward invasive approaches.
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Morin CE, Griffin LM, Beroukhim RS, Caro-Domínguez P, Chan S, Johnson JN, Infante JC, Lam CZ, Malone LJ, Tang ER, Taylor MD, Wilkinson JC, Masand PM. Imaging of pediatric cardiac tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29955. [PMID: 36083866 PMCID: PMC10641876 DOI: 10.1002/pbc.29955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/11/2022]
Abstract
Cardiac tumors in children are rare and the majority are benign. The most common cardiac tumor in children is rhabdomyoma, usually associated with tuberous sclerosis complex. Other benign cardiac masses include fibromas, myxomas, hemangiomas, and teratomas. Primary malignant cardiac tumors are exceedingly rare, with the most common pathology being soft tissue sarcomas. This paper provides consensus-based imaging recommendations for the evaluation of patients with cardiac tumors at diagnosis and follow-up, including during and after therapy.
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Affiliation(s)
- Cara E. Morin
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | | | - Pablo Caro-Domínguez
- Pediatric Radiology Unit, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Sherwin Chan
- Department of Radiology, Children’s Mercy Kansas City, Kansas City, MO; Department of Radiology, University of Missouri at Kansas City School of Medicine, Kansas City, MO
| | - Jason N. Johnson
- Department of Pediatrics and Radiology, The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN
| | - Juan C. Infante
- Department of Radiology, Nemours Children’s Hospital, Orlando, FL
| | - Christopher Z. Lam
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - LaDonna J. Malone
- Department of Radiology, University of Colorado, Children’s Hospital of Colorado, Aurora, CO
| | - Elizabeth R. Tang
- Radiology Department, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Michael D. Taylor
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - James C. Wilkinson
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX
| | - Prakash M. Masand
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital
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van Eeghen AM, Stemkens D, Fernández-Fructuoso JR, Maruani A, Hadzsiev K, Gaasterland CMW, Klein Haneveld MJ, Vyshka K, Hugon A, van Eeghen AM, van Balkom IDC. Consensus recommendations on organization of care for individuals with Phelan-McDermid syndrome. Eur J Med Genet 2023:104747. [PMID: 37003574 DOI: 10.1016/j.ejmg.2023.104747] [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: 01/02/2023] [Revised: 03/05/2023] [Accepted: 03/18/2023] [Indexed: 04/03/2023]
Abstract
The manifestations of Phelan-McDermid syndrome (PMS) are complex, warranting expert and multidisciplinary care in all life stages. In the present paper we propose consensus recommendations on the organization of care for individuals with PMS. We indicate that care should consider all life domains, which can be done within the framework of the International Classification of Functioning, Disability and Health (ICF). This framework assesses disability and functioning as the outcome of the individual's interactions with other factors. The different roles within care, such as performed by a centre of expertise, by regional health care providers and by a coordinating physician are addressed. A surveillance scheme and emergency card is provided and disciplines participating in a multidisciplinary team for PMS are described. Additionally, recommendations are provided for transition from paediatric to adult care. This care proposition may also be useful for individuals with other rare genetic neurodevelopmental disorders.
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Affiliation(s)
- A M van Eeghen
- Emma Center for Personalized Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands; Advisium, 's Heeren Loo, Amersfoort, Netherlands.
| | - D Stemkens
- VSOP - National Patient Alliance for Rare and Genetic Diseases, Soest, the Netherlands
| | | | - A Maruani
- Excellence Center for Autism Spectrum & Neurodevelopmental Disorders, Inovand, Child and Adolescent Psychiatry Department, Hôpital Robert Debre, APHP, Paris, France; CRMR DICR, Rare Disease Center for Intellectual Disabilities, Defiscience, France
| | - K Hadzsiev
- Department of Medical Genetics, Medical School, University of Pécs, Pécs, Hungary
| | - C M W Gaasterland
- Emma Center for Personalized Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - M J Klein Haneveld
- Emma Center for Personalized Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Klea Vyshka
- University Hospital Robert Debre, Paris, France
| | - A Hugon
- University Hospital Robert Debre, Paris, France
| | - A M van Eeghen
- Emma Center for Personalized Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands; Advisium, 's Heeren Loo, Amersfoort, Netherlands
| | - I D C van Balkom
- Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands; Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
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Advances in the genetics and neuropathology of tuberous sclerosis complex: edging closer to targeted therapy. Lancet Neurol 2022; 21:843-856. [DOI: 10.1016/s1474-4422(22)00213-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/09/2022] [Accepted: 05/11/2022] [Indexed: 12/23/2022]
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Wang W, Guo G, Shi G, Wei X, Hu Z, Li H, Zhang X, Ye D, Zhang Y. A Multi-Centric Study Assessing Safety and Efficacy of Everolimus in Adult Chinese Patients With Tuberous Sclerosis Complex Associated Renal Angiomyolipomas. Front Oncol 2022; 12:871723. [PMID: 35860575 PMCID: PMC9290768 DOI: 10.3389/fonc.2022.871723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEverolimus has been approved in China for adult patients with TSC-AML (tuberous sclerosis associated renal angiomyolipomas) not requiring immediate surgery and has been previously shown to be an effective treatment option for TSC-AML in the Chinese populationMethodsThis is an open label, single arm, multi-center Phase IV post-approval commitment study to further assess the safety and efficacy of everolimus in patients with TSC-AML who do not require immediate surgical intervention. The primary outcome was to evaluate the safety of everolimus while the secondary outcome was to evaluate AML response.ResultsTreatment with everolimus was associated with a clinically meaningful best overall AML response rate of 70% (95% CI: 53.5, 83.4). Of the 38 evaluable patients, 37 (97%) patients experienced a reduction in the sum of volumes of target angiomyolipoma lesions relative to baseline. At Week 12 (n=38), the median percentage change in sum of target AML volume was −56.60%, which further changed by -59.96% at Week 24 (n=38), and by −64.41% at Week 48 (n=22). Throughout the study, renal function remained relatively stable. Patients with TSC associated lymphangiomyomatosis (LAM) (N=13) demonstrated a lower than expected rate of decline in pulmonary function tests (PFTs). Everolimus was generally well tolerated with no significant safety findings in Chinese patients. Most of the adverse events were of grade 1-2, and manageable with appropriate dose adjustments and supportive therapies. There were no treatment discontinuation due to AE and no treatment death was reported.ConclusionsBased on the efficacy and safety data presented in this study, the overall clinical benefit/risk assessment further supports the use of everolimus as a viable treatment option for Chinese patients with TSC-AML.
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Affiliation(s)
- Wenda Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Guo
- Department of Urology, the Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Xin Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yushi Zhang,
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Jansen AC. Care for the caregiver! A call for action. Eur J Paediatr Neurol 2021; 35:A3-A4. [PMID: 34838446 DOI: 10.1016/j.ejpn.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Anna C Jansen
- Pediatric Neurology Unit, Department of Pediatrics, Antwerp University Hospital, Belgium.
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