Open AccessEpilepsy in tuberous sclerosis complex: Findings from the TOSCA Study
Author(s) -
Nabbout Rima,
Belousova Elena,
Benedik Mirjana P.,
Carter Tom,
Cottin Vincent,
Curatolo Paolo,
Dahlin Maria,
D´Amato Lisa,
d'Augères Guillaume Beaure,
de Vries Petrus J.,
Ferreira José C.,
Feucht Martha,
Fladrowski Carla,
Hertzberg Christoph,
Jozwiak Sergiusz,
Lawson John A.,
Macaya Alfons,
Marques Ruben,
O'Callaghan Finbar,
Qin Jiong,
Sander Valentin,
Sauter Matthias,
Shah Seema,
Takahashi Yukitoshi,
Touraine Renaud,
Youroukos Sotiris,
Zonnenberg Bernard,
Jansen Anna,
Kingswood John C.
Publication year - 2019
Publication title -
epilepsia open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.247
H-Index - 16
ISSN - 2470-9239
DOI - 10.1002/epi4.12286
Subject(s) - tuberous sclerosis , epilepsy , medicine , pediatrics , epileptic spasms , intellectual disability , seizure types , psychiatry
Summary Objective To present the baseline data of the international TuberOus SC lerosis registry to increase disease Awareness ( TOSCA ) with emphasis on the characteristics of epilepsies associated with tuberous sclerosis complex ( TSC ). Methods Retrospective and prospective patients’ data on all aspects of TSC were collected from multiple countries worldwide. Epilepsy variables included seizure type, age at onset, type of treatment, and treatment outcomes and association with genotype, seizures control, and intellectual disability. As for noninterventional registries, the study protocol did not specify any particular clinical instruments, laboratory investigations, or intervention. Evaluations included those required for diagnosis and management following local best practice. Results Epilepsy was reported in 83.6% of patients (1852/2216) at baseline; 38.9% presented with infantile spasms and 67.5% with focal seizures. The mean age at diagnosis of infantile spasms was 0.4 year (median <1 year; range <1‐30 years) and at diagnosis of focal seizures was 2.7 years (median 1 year; range <1‐66 years). A total of 1469 patients (79.3%) were diagnosed with epilepsy <2 years. The rate of infantile spasms was higher in patients with a TSC 2 mutation than in patients with a TSC 1 mutation (47.3% vs 23%). ɣ ‐aminobutyric acid (GABA) ergic drugs were the most common treatment modality for both infantile spasms (78.7%) and focal seizures (65.5%). Infantile spasms and focal seizures were controlled in 76.3% and 58.2% of patients, respectively. Control of seizures was associated with lower rates of intellectual disability in both groups. Significance This registry reports the largest international cohort of patients with TSC . Findings confirmed the typical onset pattern of infantile spasms and other focal seizures in the first 2 years of life, and the high rates of infantile spasms in patients with TSC 2 mutation. Our results underscored the occurrence of focal seizures at all ages, including an onset that preceded emergence of infantile spasms. Seizure control was shown to be associated with lower rates of intellectual disability but did not preclude the presence of intellectual disability.