A group of 2 genetic disorders characterized by problems with the skin, brain/nervous system, kidneys and a predisposition to tumors. The diseases are named after a characteristic abnormal growth in the brain in the shape of a tuber.
Causes, incidence, and risk factors
Tuberous sclerosis is inherited as an autosomal dominant trait although a high percentage of cases are due to new mutations, so there usually is no family history of the disease. It is one of a group of diseases described as neurocutaneous syndromes because of extensive involvement of both the skin and the central nervous system (brain and/or spinal cord). The symptoms of tuberous sclerosis, however, vary considerably from minimally affected people with normal intelligence and no seizures to severely affected people with profound retardation and frequent, difficult-to-control seizures or serious tumors. Severely affected people may develop heart tumors (rhabdomyoma) or seizures shortly after birth that are characterized by infantile spasms (hypsarrhythmia). Later seizures tend to be myoclonic. Mental retardation becomes evident as infants begin to miss their normal developmental milestones . Several different skin lesions are common in tuberous sclerosis.
"Ash leafs" are depigmented or hypopigmented (lacking normal skin color) white lesions that have the shape or appearance of an ash leaf and may appear anywhere on the body. Shagreen patches : These appear on the lower back as raised patches of skin with an orange-peel texture.
Adenoma sebaceum: These lesions include red, highly vascular, lumps on the face that may resemble irritated acne . These enlarge with age and may run together (become confluent) to form larger patches. The incidence is approximately 1 in 25,000-30,000 births. There are no known risk factors other than having a parent with tuberous sclerosis. In that case, each child has a 50% chance of inheriting the disease.
Signs and tests
Examination of the eyes may show retinal abnormalities, pale patches, mulberry tumor or phakoma or astrocytoma (tumor).
There may be some indications of heart abnormalities including abnormal heart rhythm (electorcardiogram) or tumor (rhabdomyoma) on ultrasound .
An MRI of the head demonstrates tumors or benign "tubers" in the brain.
A CAT scan of the head may reveal calcium deposits in the brain. The mouth may show rubbery growths in tongue or gingiva. Ultrasound of kidney may show cysts, fatty benign tumors or serious tumors. Ultraviolet light examination of the skin may show ash leaf spots not visible in ordinary light. Genetic testing for either of 2 genes TSC1 or 2 that can cause this disease may be available.
Treatment
There is no specific treatment for tuberous sclerosis per se. Treatment is tailored to the symptoms. Seizure medications are required for the control of seizures (which is often difficult). Special schooling or care is determined by the severity of mental retardation . Adenoma sebaceum (small growths) on the face may be removed by laser treatment. These lesions tend to recur and repeat treatments will be necessary. Heart tumor called rhabdomyoma may disappear after puberty so it is usually not necessary to remove it by surgery. Regular ultrasound of kidneys is important screening for adults to make sure tumors do not grow.
Support groups
Tuberous Sclerosis Alliance: www.tsalliance.org (phone: 800-225-6872)
Expectations (prognosis)
Children with minimal involvement do well. Occasionally a severely affected child will be born, the parents are examined and one of them is found to have a mild case of tuberous sclerosis that escaped detection. Children with profound retardation or uncontrollable seizures do poorly. Although numerous benign tumors occur in this disease, some, such as renal or brain tumors, can turn malignant.
Calling your health care provider
Notify your health care provider if either side of the family has a history of tuberous sclerosis. Since tuberous sclerosis also appears as a spontaneous mutation call your health care provider if you notice symptoms suggestive of tuberous sclerosis in you child. Call a geneticist if your child is diagnosed with cardiac rhabdomyoma, as tuberous sclerosis is the leading cause of this tumor.
Prevention
Genetic counseling is recommended for prospective parents with a family history of tuberous sclerosis. Prenatal diagnosis may be available for families with a known DNA mutation. Tuberous sclerosis frequently appears as a new mutation; these cases are not preventable.