Background: Tuberous sclerosis complex (TSC)-associated neuropsychiatric disorders (TAND) have unique, individual patterns that pose significant challenges for diagnosis, psycho-education, and intervention planning. A recent study suggested that it may be feasible to use TAND Checklist data and data-driven methods to generate natural TAND clusters. However, the study had a small sample size and data from only two countries. Here, we investigated the replicability of identifying natural TAND clusters from a larger and more diverse sample from the TOSCA study. Methods: As part of the TOSCA international TSC registry study, this embedded research project collected TAND Checklist data from individuals with TSC. Correlation coefficients were calculated for TAND variables to generate a correlation matrix. Hierarchical cluster and factor analysis methods were used for data reduction and identification of natural TAND clusters.

Background Tuberous sclerosis complex (TSC) is a rare multisystem autosomal dominant disorder caused by pathogenic variants in either the TSC1 or TSC2 gene. Common manifestations of TSC have been grouped into major and minor clinical diagnostic criteria and assessed in clinical routine workup. However, case studies point towards the existence of rare disease manifestations and to the potential association of TSC with malignant tumors. In this study we sought to characterize rare manifestations and malignancies using a large cohort of patients. Methods TuberOus SClerosis registry to increAse disease awareness (TOSCA) is a multicenter, international disease registry collecting clinical manifestations and characteristics of patients with TSC, both retrospectively and prospectively. We report rates and characteristics of rare manifestations and malignancies in patients with TSC who had enrolled in the TOSCA registry. We also examined these manifestations by age, sex, and genotype (TSC1 or TSC2). Results Overall, 2211 patients with TSC were enrolled in the study. Rare manifestations were reported in 382 (17.3%) study participants and malignancies in 65 (2.9%). Of these rare manifestations, the most frequent were bone sclerotic foci (39.5%), scoliosis (23%), thyroid adenoma (5.5%), adrenal angiomyolipoma (4.5%), hemihypertrophy and pancreatic neuroendocrine tumors (pNET; both 3.1%). These rare manifestations were more commonly observed in adults than children (66.2% vs. 22.7%), in females versus males (58.4% vs. 41.6%; except for scoliosis: 48.9% vs. 51.1%), and in those with TSC2 versus TSC1 (67.0% vs. 21.1%; except for thyroid adenoma: 42.9% vs. 57.1%). In the 65 individuals with reported malignancies, the most common were renal cell carcinoma (47.7%), followed by breast (10.8%) and thyroid cancer (9.2%). Although malignancies were more common in adult patients, 26.1% were reported in children and 63.1% in individuals < 40 years. TSC1 mutations were over-represented in individuals with malignancies compared to the overall TOSCA cohort (32.1% vs. 18.5%). Conclusion Rare manifestations were observed in a significant proportion of individuals with TSC. We recommend further examination of rare manifestations in TSC. Collectively, malignancies were infrequent findings in our cohort. However, compared to the general population, malignant tumors occurred earlier in age and some tumor types were more common.

The prevalence of attention deficit hyperactivity disorder (ADHD) in young schoolchildren in Nefteyugansk (Khanty-Mansiiskii Autonomous Region) was found to be 8%, with rates of 13% amongst boys and 3% amongst girls. Clinical investigation of a cohort of 122 children aged 6-11 years identified risk factors for the formation of ADHD as perinatal CNS injuries, inherited predisposition, and unfavorable social-psychological influences. Neuropsychological, neurophysiological (electroencephalography), and biochemical studies identified minor neurological abnormalities, some characteristic features of the motor and emotional spheres, and changes in higher mental functions. In addition, biochemical changes consisting of decreases in plasma and erythrocyte magnesium levels and decreases in Mg(2+)-ATPase activity were identified. Treatment with MAGNE-B(6) allowed correction of many of these changes.

Цель статьи: описать особенности дифференциальной диагностики гипофосфатазии с рахитоподобными заболеваниями на примере нескольких клинических случаев. Основные положения. Причиной гипофосфатазии является снижение активности щелочной фосфатазы (ЩФ), приводящее к поражению всех органов и тканей различной степени тяжести с многообразными проявлениями. Неспецифическая клиническая картина редкого наследственного метаболического заболевания, низкая осведомленность врачей о проблеме определяют трудности диагностики гипофосфатазии. Единственный метод патогенетического лечения гипофосфатазии-пожизненная ферментная заместительная терапия препаратом асфотаза альфа. В статье приведены клинические случаи перинатальной (более тяжелой) и детской формы заболевания. Заключение. Наличие гипофосфатазии следует проверять у всех пациентов с признаками гипоминерализации костей в сочетании с полиорганными нарушениями и/или судорожным синдромом, патологией зубочелюстного аппарата и снижением активности ЩФ. Важно отметить, что показатели активности ЩФ имеют возрастные особенности, следовательно, лечащий врач должен убедиться, что сообщаемые лабораторией результаты отражают нормальный для пациента конкретного возраста уровень ЩФ. Ключевые слова: гипофосфатазия, щелочная фосфатаза, метаболические заболевания, дети, асфотаза альфа.

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