Neuropediatrics 2023; 54(05): 335-338
DOI: 10.1055/s-0043-1770937
Short Communication

Neurodevelopmental Outcomes of a Cohort of Children with Tuberous Sclerosis Complex with Epileptic Spasms

Lokesh Saini*
1   Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Swetlana Mukherjee*
2   Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
1   Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Prahbhjot Malhi
2   Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
2   Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Rajni Sharma
2   Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
3   Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Renu Suthar
2   Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Jitendra Kumar Sahu
2   Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Naveen Sankhyan
2   Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations
Funding None.

Abstract

The neurodevelopmental outcomes in children with tuberous sclerosis complex (TSC) with epileptic spasms remain underdiagnosed and might be responsible for significant morbidity and mortality burdens, even after spasms abate. The study was a cross-sectional study over 18 months at a tertiary care pediatric hospital, involving 30 children with TSC who had epileptic spasms. They were assessed with Diagnostic and Statistical Manual of Mental Disorders-5 criteria for autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intellectual disability (ID), and childhood psychopathology measurement schedule (CPMS) for behavioral disorders. The median age at onset of epileptic spasms was 6.5 (1–12) months, and the age at enrolment was 5 (1–15) years. Of 30 children, 2 (6.7%) had only ADHD, 15 (50%) had only ID/GDD (global developmental delay), 4 (13.3%) had ASD and ID/GDD, 3 (10%) had ADHD and ID/GDD, and 6 (20%) had none. The median intelligence quotient/development quotient (IQ/DQ) score was 60.5 (20–105). CPMS assessment revealed significant behavioral abnormalities in almost half the children. Eight (26.7%) patients were completely seizure-free for at least 2 years, 8 (26.7%) had generalized tonic-clonic seizures, 11 (36.6%) had focal epilepsy, and 3 (10%) had evolved into Lennox-Gastaut syndrome. A high proportion of neurodevelopment disorders, including ASD, ADHD, ID/GDD, and behavioral disorders were seen in this pilot study with a small cohort of children with TSC with epileptic spasms.

Authors' Contributions

L.K. and S.M. helped in study design, writing, editing, and drafting. P.M., J.K.S., and N.S. contributed to intellectual content. L.S., S.M., P.K.G., P.M., A.G.S., R.S., I.K.S., R.S., J.K.S., and N.S. were involved in critical revision and final approval.


Note

The authors want to disclose that this research article is a part of larger study on children with neurocutaneous syndromes.


Ethical Statement

We confirm that we have read the journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.


* Both authors contributed equally and shares joint first authorship.




Publication History

Received: 16 February 2023

Accepted: 29 May 2023

Article published online:
28 June 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Brigo F, Lattanzi S, Trinka E. et al. First descriptions of tuberous sclerosis by Désiré-Magloire Bourneville (1840-1909). Neuropathology 2018; 38 (06) 577-582
  • 2 Online Mendelian Inheritance in Man. . OMIM®. Johns Hopkins University, Baltimore, MD. MIM Number: *605284 - TSC complex subunit 1; TSC1. https://www.omim.org/entry/605284 . MIM Number: *191092 - TSC complex subunit 2; TSC2. https://www.omim.org/entry/191092
  • 3 Northrup H, Krueger DA, Roberds S. et al; International Tuberous Sclerosis Complex Consensus Group. Tuberous sclerosis complex diagnostic criteria update: recommendations of the 2012 International Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol 2013; 49 (04) 243-254
  • 4 Zamora EA, Aeddula NR. Tuberous sclerosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Accessed June 15, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK538492//
  • 5 de Vries PJ, Belousova E, Benedik MP. et al; TOSCA Consortium and TOSCA Investigators. TSC-associated neuropsychiatric disorders (TAND): findings from the TOSCA natural history study. Orphanet J Rare Dis 2018; 13 (01) 157
  • 6 Riikonen R, Simell O. Tuberous sclerosis and infantile spasms. Dev Med Child Neurol 1990; 32 (03) 203-209
  • 7 O'Callaghan FJK, Harris T, Joinson C. et al. The relation of infantile spasms, tubers, and intelligence in tuberous sclerosis complex. Arch Dis Child 2004; 89 (06) 530-533
  • 8 van der Poest Clement EA, Sahin M, Peters JM. Vigabatrin for epileptic spasms and tonic seizures in tuberous sclerosis complex. J Child Neurol 2018; 33 (08) 519-524
  • 9 Bombardieri R, Pinci M, Moavero R, Cerminara C, Curatolo P. Early control of seizures improves long-term outcome in children with tuberous sclerosis complex. Eur J Paediatr Neurol 2010; 14 (02) 146-149
  • 10 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013
  • 11 Malins AJ. Malins Intelligence Scale for Children- Manual. Lucknow: Indian Psychological Corporation; 1969
  • 12 Alpern GD. Developmental Profile III. Los Angeles, CA: Western Psychological Services; 2007
  • 13 Malhotra S, Varma VK, Verma SK, Malhotra A. Childhood psychopathology measurement schedule: development and standardization. Indian J Psychiatry 1988; 30 (04) 325-331
  • 14 Webb DW, Fryer AE, Osborne JP. Morbidity associated with tuberous sclerosis: a population study. Dev Med Child Neurol 1996; 38 (02) 146-155
  • 15 Kotulska K, Kwiatkowski DJ, Curatolo P. et al; EPISTOP Investigators. Prevention of epilepsy in infants with tuberous sclerosis complex in the EPISTOP trial. Ann Neurol 2021; 89 (02) 304-314