Childhood tuberous sclerosis complex in southern Sweden: a paradigm shift in diagnosis and treatment

Abstract

Aim To investigate the complete clinical spectrum of individuals with paediatric tuberous sclerosis complex in southern Sweden and explore changes over time. Methods In this retrospective observational study, 52 individuals aged up to 18 years at the study start were followed-up at regional hospitals and centres for habilitation from 2000 to 2020. Results Cardiac rhabdomyoma was detected prenatally/neonatally in 69.2% of the subjects born during the latest ten years of the study period. Epilepsy was diagnosed in 82.7% of subjects, and 10 (19%) were treated with everolimus, mainly (80%) for a neurological indication. Renal cysts were detected in 53%, angiomyolipomas in 47%, astrocytic hamartomas in 28% of the individuals. There was a paucity of standardized follow-up of cardiac, renal, and ophthalmological manifestations and no structured transition to adult care. Conclusion Our in-depth analysis shows a clear shift towards an earlier diagnosis of tuberous sclerosis complex in the latter part of the study period, where more than 60% of cases showed evidence of this condition already in utero due to the presence of a cardiac rhabdomyoma. This allows for preventive treatment of epilepsy with vigabatrin and early intervention with everolimus for potential mitigation of other symptoms of tuberous sclerosis complex.

Exploring Cardiovascular Involvement in Tuberous Sclerosis: Insights for Pediatric Clinicians

“…Similarly, across the age groups represented in TOSCA, cardiac tumours were reported together with hypomelanotic macules and central nervous system tumours starting from age under 2 years, while the diagnosis of TSC in adulthood was based on the presence of renal angiomyolipomas, facial angiofibromas, fibrous cephalic plaques and shagreen patches [ 7 ]. In addition to the above evidence, Pearsson et al revealed a scarcity of standardized management and follow-up of the cardiac, renal and ophthalmological manifestations of TS patients [ 13 ]. These arguments represent the main incentives for our present review.…”

Ophthalmic manifestations in children with tuberous sclerosis complex

“…Genetic analyses for our TSC patients have been published previously (Pearsson et al, 2023). The prevalence of TSC in Sweden has been calculated to 5.38/100 000 (Welin et al, 2017) and incidence numbers of TSC are between 1:5800 and 1:13 520 live births (Northrup et al, 2021).…”