OCULAR FINDINGS OF TUBEROUS SCLEROSIS – A CASE REPORT

The term “Neurocutaneous syndromes” also known as Phakomatoses refers to a broadcategory of congenital diseases that includes anomalies of neuroectodermal and occasionallymesodermal development, hence commonly involving the skin, eyes and central nervoussystem. The term Phacomatoses was coined by Van Der Hoeve in 1921. Tuberous sclerosisis one type of Neurocutaneous syndromes. The word "tuberous sclerosis" comes from thedistinctive cortical tubers that Désiré-Magloire first described. Tuberous sclerosis is ahereditary disorder that affects numerous body systems. A 30 year old female diagnosed asTuberous sclerosis was referred by Dermatology Department. Detailed ophthalmicexamination was done. Patient was diagnosed with Adenoma sebaceum of upper eyelids inboth eyes and multiple retinal hamartoma in left eye.

Everolimus as a therapeutic option in refractory epilepsy in children with tuberous sclerosis: a systematic review / Everolimo como opção terapêutica na epilepsia refratária em crianças com esclerose tuberosa: uma revisão sistemática

Abstract Background Tuberous sclerosis (TS) is a multisystem genetic disease in which epilepsy is a frequent manifestation and is often difficult to control. Everolimus is a drug with proven efficacy in the treatment of other conditions related to TS, and some evidence suggests that its use benefits the treatment of refractory epilepsy in these patients. Objective To evaluate the efficacy of everolimus in controlling refractory epilepsy in children with TS. Methods A literature review was conducted in the Pubmed, BVS, and Medline databases, using the descriptors Tuberous sclerosis, Children, Epilepsy, and Everolimus. Original clinical trials and prospective studies published in Portuguese or English in the last decade that evaluated the use of everolimus as an adjuvant therapy in the control of refractory epilepsy in pediatric patients with TS were included. Results Our search screened 246 articles from electronic databases, 6 of which were chosen for review. Despite the methodological variations between the studies, most patients benefited from the use of everolimus to control refractory epilepsy, with response rates ranging from 28.6 to 100%. Adverse effects were present in all studies leading to dropouts of some patients; however, the majority were of low severity. Conclusion The selected studies suggest a beneficial effect of everolimus in the treatment of refractory epilepsy in children with TS, despite the adverse effects observed. Further studies involving a larger sample in double-blind controlled clinical trials should be performed to provide more information and statistical credibility.

Resumo Antecedentes A esclerose tuberosa (ET) é uma doença genética multissistêmica na qual a epilepsia é a manifestação neurológica mais frequente, sendo muitas vezes de difícil controle. O everolimo é uma droga com eficácia comprovada no tratamento de outras condições relacionadas à ET, e indícios sugerem benefícios de seu uso também no controle da epilepsia refratária nesses pacientes. Objetivo Avaliar a eficácia do everolimo no controle da epilepsia refratária em crianças com ET. Métodos Revisão de literatura nas bases de dados Pubmed, BVS e Medline, utilizando os descritores Tuberous sclerosis, Children, Epilepsy e Everolimus. Incluíram-se ensaios clínicos originais e estudos prospectivos publicados em português ou inglês na última década e que avaliassem o uso do everolimo como terapia adjuvante no controle da epilepsia refratária em pacientes pediátricos com ET. Resultados Nossa busca rastreou 246 artigos nas bases de dados, dos quais 6 foram escolhidos para a revisão. Apesar das variações metodológicas entre os estudos, a maioria dos pacientes tiveram benefício no uso do everolimo para controle da epilepsia refratária, com taxas de resposta variando entre 28.6 e 100%. Os efeitos adversos estiveram presentes em todos os estudos, levando à desistência de alguns pacientes, contudo a maioria foi de baixa gravidade. Conclusão Os estudos selecionados sugerem efeito benéfico do everolimo no tratamento da epilepsia refratária em crianças com ET, apesar dos efeitos adversos observados. Novos estudos envolvendo uma amostra maior em ensaios clínicos controlados duplo-cegos devem ser realizados para fornecer mais informações e credibilidade estatística.

Endovascular treatment of intrarenal aneurysms bleeding and angiomyolipomas in a patient with tuberous sclerosis and polycystic kidney disease / Tratamento endovascular de sangramentos e angiomiolipomas de aneurismas intrarrenais em um paciente com esclerose tuberosa e doença renal policística

Abstract Tuberous sclerosis complex (TSC) and autosomal dominant polycystic kidney disease (ADPKD) are conditions related to renal failure that can rarely occur in association as a contiguous gene syndrome. Angiomyolipomas (AMLs) are renal tumors strongly related to TSC that may rupture and cause life-threatening bleedings. We present a patient with TSC, ADPKD, and renal AMLs with persistent hematuria requiring blood transfusion. The persistent hematuria was successfully treated through endovascular embolization, a minimally invasive nephron sparing technique.

Resumo O complexo de esclerose tuberosa (CET) e a doença renal policística autossômica dominante (DRPAD) são condições relacionadas à insuficiência renal que raramente podem ocorrer em associação como uma síndrome do gene contíguo. Angiomiolipomas (AMLs) são tumores renais fortemente relacionados ao CET que podem romper-se e causar hemorragias com risco de vida. Apresentamos um paciente com CET, DRPAD e AMLs renais com hematúria persistente que requer transfusão sanguínea. A hematúria persistente foi tratada com sucesso por meio de embolização endovascular, uma técnica de preservação do néfron minimamente invasiva.

Diagnóstico prenatal y seguimiento de tumores cardiacos fetales: serie de casos y revisión de la literatura

Antecedentes. Los tumores cardiacos son frecuentes en la etapa fetal e infantil, siendo el rabdomioma el más prevalente en la vida fetal. Su diagnóstico se ha incrementado debido al cribado por ecografía. Objetivo. Comunicar la primera serie peruana de casos con diagnóstico prenatal de tumores cardiacos fetales en un instituto materno perinatal. Métodos. Estudio descriptivo de serie de casos. Se revisó la base de datos de todos los fetos con diagnóstico prenatal de tumores cardiacos a partir de enero de 2009 hasta enero de 2021 en el Instituto Nacional Materno Perinatal (INMP), Lima, Perú. Estos pacientes fueron seguidos por vía telefónica y en dos casos se les realizó control ecocardiográfico. Resultados. Se halló 6 casos de pacientes diagnosticados con tumores cardiacos en los últimos 12 años en el INMP, con reducción de tamaño en el seguimiento de todos los casos y la asociación con esclerosis tuberosa en la mitad de ellos. Conclusiones. Los rabdomiomas cardiacos representan los tumores más frecuentes en la vida fetal. La mayoría tienen en común la remisión parcial del tumor. Sin embargo, la evolución clínica depende de la ubicación, tamaño y su asociación o no de esclerosis tuberosa. Por ello es recomendable un seguimiento estricto, especialmente del sistema nervioso central.

Background: Cardiac tumors are frequent in the fetal and infant stages, with rhabdomyoma being the most prevalent in fetal life. Its diagnosis has increased due to ultrasound screening. Objective: To report the first Peruvian series of cases with prenatal diagnosis of fetal cardiac tumors in a maternal perinatal institute. Methods: Descriptive study of case series. The database of all fetuses with prenatal diagnosis of cardiac tumors from January 2009 to January 2021 at the Instituto Nacional Materno Perinatal (INMP), Lima, Peru, was reviewed. These patients were followed up by telephone and in two cases echocardiographic control was performed. Results: We found 6 cases of patients diagnosed with cardiac tumors in the last 12 years in the INMP, with reduction in size in the follow-up of all cases and association with tuberous sclerosis in half of them. Conclusions: Cardiac rhabdomyomas represent the most frequent tumors in fetal life. Most of them have in common the partial remission of the tumor. However, the clinical evolution depends on the location of the tumor, size, and its association or not with tuberous sclerosis. For this reason, close follow-up is recommended, especially of the central nervous system.

Construction of CRISPR/Cas9 system targeting mouse Tsc1 and Tsc2 gene and verification of targeting effectiveness / 中国生物制品学杂志

@#ObjectiveTo design and construct CRISPR/Cas9 gene editing system targeting Tsc1 and Tsc2 genes,and verify the effectiveness of gene editing at cellular level.MethodsThree sgRNA guide sequences were designed for mouse Tsc1 and Tsc2 genes respectively. The sgRNA expression vector was constructed and co-transfected with the Cas9 expression plasmid into mouse N2a cells. After the positive cells were obtained through drug screening,the DNA fragments at the targeting site were amplified by PCR,and the targeting efficiency was verified by TA clone sequencing.ResultsThe five targets of Tsc1-M-sgRNA2 and Tsc1-M-sgRNA3 of Tsc1 gene and Tsc2-M-sgRNA1,Tsc2-M-sgRNA2 and Tsc2-M-sgRNA3 of Tsc2 gene were all edited,and the editing efficiency was 40%,80%,30%,30% and 20%,respectively.ConclusionA CRISPR-Cas9 gene editing system with editing efficiency targeting mouse Tsc1 and Tsc2 genes was successfully constructed.

Progress in efficacy and safety of vigabatrin in treatment of epilepsy associated with tuberous sclerosis complex in children / 国际儿科学杂志

Tuberous sclerosis complex(TSC)is an autosomal dominant skin-nerve syndrome with diverse clinical manifestations.Epilepsy is the most common neurological manifestation.Vigabatrin(VGB)is an inhibitory neurotransmitter γ-aminobutyric acid(GABA)analogue.It reduces the degradation of GABA by irreversibly binding to GABA transaminase, thereby increasing the level of GABA in the central nervous system and exerting anti-epileptic effects.It is suitable for the treatment of various types of epilepsy related to TSC.In recent years, the preventive effect of VGB in TSC-related epilepsy has attracted wide attention.There is a certain degree of adverse reactions during the use of VGB, the most noteworthy of which is the visual field and central nervous system changes.This article reviews the efficacy and safety of VGB in the treatment of TSC-related epilepsy.

Progress in the Treatment of Topical Rapamycin Preparations / 罕见病研究

Rapamycin is a mammalian target of rapamycin(mTOR) receptor inhibitor. Advances in the understanding of the mTOR signaling pathway and its downstream effects on tumorigenesis and vascular proliferation have broadened the clinical applications of mTOR receptor inhibitors in treating many challenging diseases. Rapamycin is used orally for the treatment of kidney transplantation, lymphatic leiomyomatosis of lung, tuberous sclerosis complex(TSC), and etc. But systemic therapy using the rapamycin has significant side effects. To mitigate the side effects of systemic rapamycin for dermatologic applications, clinicians have used topical therapy. In recent years, research publications on the topical rapamycin in the treatment of a variety of diseases have increased, as on such diseases of facial angiofibroma of tuberous sclerosis complex, lymphatic malformation, Kaposi hemangioendothelioma, tufted angiomas, and etc. Topical rapamycin can be used as an effective long-term therapy while avoiding systemic side effects, providing a new treatment method for dermatologists. This paper discusses the progress in the treatment of topical rapamycin preparations.

Nueva mutación en el gen TSC2 protege contra el cáncer colorrectal en población mexicana / A novel mutation in the TSC2 gene protects against colorectal cancer in the Mexican population

Resumen Introducción: El cáncer colorrectal (CCR) es una enfermedad compleja debido al gran número de factores que influyen en su desarrollo, incluyendo variantes en genes supresores de tumores. Objetivo: Estimar las frecuencias alélicas y genotípicas de las variantes c.3915G>A y c.5371G>A del gen TSC2 en una población mexicana con CCR, así como analizar la asociación con el desarrollo de CCR. Métodos: Se incluyeron 126 muestras de sangre periférica de pacientes con diagnóstico de CCR esporádico y 134 de individuos sanos, considerados como grupo de control. La identificación de los genotipos se llevó a cabo mediante PCR tradicional y digestión enzimática. Todos los individuos firmaron una carta de consentimiento informado. Resultados: El alelo A de la variante c.3915G>A (RM = 0.31, IC 95 % = 0.15-0.69, p = 0.004), así como el haplotipo A/G de las variantes c.3915G>A y c.5371G>A (RM = 0.28, IC 95 % = 0.12-0.68, p = 0.005) mostraron un posible efecto protector contra CCR esporádico. El análisis in silico indicó que ambas variantes generan modificaciones en el proceso de corte y empalme. Conclusión: La presencia de la variante c.3915G>A del gen TSC2 sugiere un posible efecto protector contra CCR esporádico en población mexicana; sin embargo, no se observó esta asociación con la variante c.5371G>A.

Abstract Introduction: Colorectal cancer (CRC) is a complex disease due to the large number of factors that influence its development, including variants in tumor suppressor genes. Objective: To estimate allelic and genotypic frequencies of c.3915G>A and c.5371G>A variants of the TSC2 gene in a Mexican population with CRC, as well as to analyze their association with the development of CRC. Methods: 126 peripheral blood samples from patients diagnosed with sporadic CRC and 134 from healthy individuals, regarded as the control group, were included. Identification of genotypes was carried out using traditional PCR and enzymatic digestion. All individuals signed an informed consent letter. Results: The A allele of the c.3915G>A variant (OR = 0.31, 95% CI = 0.15-0.69, p = 0.004), as well as A/G haplotype of the c.3915G>A and c.5371G>A variants (OR = 0.28, 95% CI = 0.12-0.68, p = 0.005) showed a possible protective effect against sporadic CRC. In silico analysis indicated that both variants generate modifications in the splicing process. Conclusion: The presence of TSC2 gene c.3915G>A variant suggests a possible protective effect against sporadic CRC in the Mexican population; however, no association was observed with the c.5371G>A variant.

Use of cannabidiol in the treatment of epilepsy: Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex

SUMMARY OBJECTIVE: The objective of this systematic review with meta-analysis was to evaluate the efficacy, safety, and short- and long-term tolerability of cannabidiol (CBD), as an adjunct treatment, in children and adults with Dravet syndrome (SD), Lennox-Gataut syndrome (LGS), or tuberous sclerosis complex (TSC), with inadequate control of seizures. METHODS: This systematic review was conducted through a search for scientific evidence in the Mediline/PubMed, Central Cochrane, and ClinicalTrials.gov databases until April 2022. Selected randomized clinical trials (RCTs) that presented the outcomes: reduction in the frequency of seizures and total seizures (all types), number of patients with a response greater than or equal to 50%, change in caregiver global impression of change (CGIC) (improvement ≥1 category on the initial scale), adverse events (AEs), and tolerability to treatment. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses. RESULTS: Notably, six RCTs were included, with a total of 1,034 patients with SD, LGS, and TSC, of which 3 were open-label extension RCTs. The meta-analysis of the studies showed that the use of CBD as compared with placebo, in patients with convulsive seizures refractory to the use of medications, reduces the frequency of seizures by 33%; increases the number of patients with a reduction ≥50% in the frequency of seizures by 20%; increases the number of patients with absence of seizures by 3%; improves the clinical impression evaluated by the caregiver or patient (S/CGIC) in 21%; increases total AEs by 12%; increases serious AE by 16%; increases the risk of treatment abandonment by 12%; and increases the number of patients with transaminase elevation (≥3 times the referral) by 15%. CONCLUSIONS: This systematic review, with meta-analysis, supports the use of CBD in the treatment of patients with seizures, originated in DS, LGS, and TSC, who are resistant to the common medications, presenting satisfactory benefits in reducing seizures and tolerable toxicity.

Clinical profile of tuberous sclerosis complex patients with and without epilepsy: a need for awareness for early diagnosis / Perfil clínico de pacientes com complexo de esclerose tuberosa com e sem epilepsia: uma necessidade de conscientização para o diagnóstico precoce

Abstract Background Tuberous sclerosis complex (TSC) is a multisystemic disorder. Its clinical features manifest differently in several organs, prompting the need for better knowledge. Objective The goal of the present study is to evaluate the neurological findings of TSC, such as cerebral lesions and epilepsy, and to raise awareness of non-neurological findings that could contribute to an earlier diagnosis and treatment. Methods This was a natural history study of patients with a definitive diagnosis of TSC who were referred to a specialized outpatient clinic and followed-up for 2 years with clinical and radiological exams. Results A total of 130 TSC patients (59 males [45.4%], mean age 20.4 years old [1 to 56 years old]); 107 patients (82.3%) were diagnosed with epilepsy. Seizures predominantly began at < 1 year old (72.8%); focal seizures predominated (86.9%); epileptic spasms occurred in 34.5% of patients, and refractory epilepsy was present in 55.1%. Neuropsychiatric disorders, cortical tubers and cerebellar tubers were significantly more frequent in the epilepsy group. Moreover, rhabdomyomas were significantly more frequent in the epilepsy group (p = 0.044), while lymphangioleiomyomatosis was significantly less frequent in the epilepsy group (p = 0.009). Other non-neurological findings did not differ significantly between the groups with and without epilepsy. Conclusions The present study of TSC patients demonstrated the predominantly neurological involvement and significantly higher proportion of TSC-associated neuropsychiatric disorders in the epilepsy group. Higher proportions of cortical and cerebellar tubers may be a risk factor for epilepsy and neurodevelopmental disorders.

Resumo Antecedentes O Complexo da esclerose tuberosa (CET) é uma doença multissistêmica. As apresentações clínicas em diferentes órgãos são diversas, necessitando um maior conhecimento da doença. Objetivo O objetivo do presente estudo foi avaliar na CET o envolvimento neurológico, como lesões cerebrais e epilepsia, e chamar a atenção para achados não neurológicos que contribuiriam para o diagnóstico e tratamento precoces. Métodos Estudo de história natural do CET em pacientes com critérios diagnósticos definidos encaminhados aleatoriamente para serviço especializado e que foram acompanhados, durante 2 anos, com exames clínicos e radiológicos. Resultados O total de 130 pacientes (59 do sexo masculino [45.4%]), idade média de 20,4 anos [1 a 56 anos]) foram avaliados; 107 pacientes (82.3%) foram diagnosticados com epilepsia. As crises epilépticas se iniciaram especialmente em pacientes < 1 ano de idade (72,8%); predomínio de crise focal (86,9%); ocorrência de espasmos infantis em 34,5% deles e de epilepsia refratária em 55,1%. A frequência de distúrbios neuropsiquiátricos, túberes corticais e túberes cerebelares foi significativamente mais frequente no grupo com epilepsia. Além disso, rabdomioma foi significativamente mais frequente no grupo com epilepsia (p = 0,044), enquanto a linfoangioleiomiomatose foi significativamente menos frequente (p = 0,009). Outros comprometimentos não neurológicos, como os oftalmológicos e os nefrológicos, não diferiram significativamente nos grupos com e sem epilepsia. Conclusões O presente estudo com pacientes com CET com e sem epilepsia pode demonstrar uma maior proporção significativa de transtornos neuropsiquiátricos associados ao CET no grupo com epilepsia. A maior proporção de túberes corticais e cerebelares parecem ser um fator de risco para epilepsia e para o comprometimento do neurodesenvolvimento.

COMPLEJO ESCLEROSIS TUBEROSA: a propósito de un caso clínico / TUBEROUS SCLEROSIS COMPLEX: about a clinical case

RESUMEN El Complejo Esclerosis Tuberosa (CET) es un síndrome neurocutáneo multisistémico que pertenece al grupo de las genodermatosis, de transmisión de herencia autosómica dominante con alta penetrancia y muy variable expresividad fenotípica. Es producido por mutaciones en los genes TSC1 y TSC2. Se caracteriza por la triada de epilepsia, retraso madurativo y angiofibromas. El diagnóstico es clínico y consiste en ensamblar los signos clínicos identificados, con los criterios diagnósticos consensuados de criterios principales y secundarios. Presentamos un paciente adulto con antecedentes de retraso madurativo y epilepsia desde la infancia en tratamiento y seguimiento por neurología desde entonces; y antecedentes familiares de síndrome convulsivo en sus hermanos, a quien se le realiza diagnóstico tardío de CET al momento de la consulta, cumpliendo con los criterios para el mismo.

ABSTRACT Tuberous Sclerosis Complex (TSC) is an autosomal dominant multisystem neurocutaneous syndrome with almost complete penetrance but variable expressivity. This genodermatosis occurs upon mutation of TSC1 and TSC2 genes. It is characterized by the classic triad of seizures, mental retardation and cutaneous angiofibromas. The diagnosis of TSC is based by the presence of major and minor criteria. We report the case of an adult male patient with personal history of mental retardation in addition with personal and family history of seizures since childhood.

A CASE REPORT OF TUBEROUS SCLEROSIS WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER IN A CHILD

Tuberous sclerosis is an autosomal dominant genetic disorder characterized by the formation of hamartomas. These mostly affect the skin, eyes, brain, heart, kidneys and lungs. Cutaneous manifestations like adenoma sebaceum, shagreen patch etc., are apparent on physical examination. Tuberous sclerosis is associated with a wide range of behavioral, psychiatric, neurological, intellectual and psychosocial dif?culties. Around 90% of individuals with tuberous sclerosis have neuropsychiatric manifestations. The diagnostic triad of tuberous sclerosis consists of mental retardation, adenoma sebaceum and epilepsy. Attention de?cit hyperactivity disorder is also found as a comorbidity in tuberous sclerosis in higher percentage. Here we present a case of a child suffering from tuberous sclerosis and presenting with attention de?cit hyperactivity disorder and seizures

Clinical phenotype and gene analysis of TSC2/PKD1 adjacency gene syndrome / 中华神经科杂志

Objective:To explore the clinical phenotype and gene characteristics of a case of TSC2/PKD1 adjacency gene syndrome, so as to improve the clinical understanding of the disease.Methods:A case of TSC2/PKD1 adjacency gene syndrome diagnosed in the Department of Neurology of the Children′s Hospital Affiliated to Zhengzhou University was analyzed retrospectively. The clinical data, laboratory examination, imaging characteristics and gene variation characteristics of the child were summarized.Results:The patient was a 17 months old girl, with the main complaint of "intermittent convulsion with 17 months of underdevelopment". The clinical manifestations were epileptic seizures, which were in the form of a series of spastic seizures, absence seizures, focal seizures, and depigmentation spots can be seen in the trunk and neck. Cranial magnetic resonance imaging showed multiple patchy signals in the cortex and subcortical areas of the bilateral cerebral hemispheres, multiple small nodular shadows under the ependyma of the bilateral lateral ventricles, the heart color Doppler ultrasound showed patent foramen ovale and pericardial effusion, and the abdomen color Doppler ultrasound showed polycystic kidney. Ophthalmic color Doppler ultrasound showed that there were localized small swelling lesions around the optic disc of the left eye. The whole exon gene sequencing of the pedigree showed the proband had partial deletion of TSC2 gene (NM_000548) at chromosome position chr16: 2125799-2185690. The real-time quantitative detection system verified that exons 23-42 were deleted, and all exons of PKD1 gene were deleted (NM_001009944), and multiple ligation dependent probe amplification verified that exons 1-46 were deleted, and no downstream gene deletion was found. The overall deletion size was about 60 kb. Both of the girl's father and mother had normal phenotypes and were wild-type.Conclusions:TSC2/PKD1 adjacency gene syndrome is relatively rare. It can have clinical manifestations of tuberous sclerosis/autosomal dominant polycystic kidney disease. Most of the nervous system and kidney are seriously affected, and the prognosis is poor. TSC2/PKD1 gene deletion and variation is the genetic cause of the TSC2/PKD1 adjacency gene syndrome.

Analysis of clinical phenotype and gene variants in a patient with classic tuberous sclerosis complex / 中华皮肤科杂志

Objective:To analyze clinical phenotypes and pathogenic mutations of a patient with classic tuberous sclerosis complex.Methods:Clinical data was collected from a patient with classic tuberous sclerosis complex. Next-generation sequencing was performed to screen pathogenic gene variants, and Sanger sequencing to verify the mutations. Minigene plasmids were constructed and transfected into the human renal epithelial cell line 293T, and RNA was extracted for transcriptional analysis.Results:The patient clinically presented with recurrent epileptic seizures, facial angiofibroma, periungual fibroma, pulmonary lymphangioleiomyomatosis, renal angiomyolipoma and multiple osteosclerosis. Next-generation sequencing revealed a suspected pathogenic variant in the TSC2 gene in the patient. Sanger sequencing identified a heterozygous mutation c.336_336+15delGGTAAGGCCCAGGGCG in exon 4 of the TSC2 gene in the patient, but not in his parents or 100 unrelated healthy controls. Moreover, this mutation had not been previously reported. The minigene experiment showed changed mRNA sequence of the TSC2 gene in this patient with loss of the authentic splice site in exon 4 and insertion of a 74-bp intron, which shifted the splice site 90 bp downstream (r.336delins336+16_336+90) .Conclusion:The novel heterozygous mutation c.336_336+15delGGTAAGGCCCAGGGCG in exon 4 of the TSC2 gene can lead to aberrant splicing, and may contribute to tuberous sclerosis complex in this patient.

Importancia del uso de la genómica en el diagnóstico precoz de la esclerosis tuberosa, reporte de caso / The importance of the use of genomics in early diagnosis of tuberous sclerosis: case report

Introduccion: La esclerosis tuberosa en un trastorno raro con manifestaciones clínicas multisistémicas que puede comprometer órganos vitales como riñón pulmón y corazón por lo que requiere un diagnóstico precoz para brindar un tratamiento oportuno y dirigido mejorando el pronóstico y disminuyendo la morbimortalidad atribuida a esta patología. Objetivo: Establecer la importancia del uso de la genómica y la correlación fenotipo-genotipo para el diagnóstico, tratamiento, seguimiento, pronóstico, asesoramiento genético de la esclerosis tuberosa. Materiales y métodos: Reporte de caso de paciente 15 años con angiofibromas corporales, hamartoma retiniano, angiomiolipoma derecho y alteraciones de estudios de neuroimagen sin convulsiones ni trastornos neuroconductuales, se sospecho clínicamente de esclerosis tuberosa con confirmación genética al tener una variante patogénica en estado de heterocigosis en el gen TSC2. Resultados: Se encontró una deleción heterocigota patogénica que cambia una citosina en la posición 2.539 del ADNc del gen TSC2 (c.2539delC), que lleva a un codón de parada prematuro en el aminoácido 893 (p. Leu847Cysfs*47) en una proteína de 1.807 aminoácidos con significado clínico patogénico. Conclusiones: El complejo esclerosis tuberosa constituye una enfermedad huérfana para Colombia dada la baja prevalencia poblacional, con una alta carga en morbilidad y mortalidad debido al compromiso multisistémico. Su confirmación se realiza mediante métodos moleculares ­ genómicos que permiten establecer correlación fenotipo-genotipo dada la variabilidad en las variantes reportadas en este gen y los diferentes grados de expresión fenotípicos en los individuos, lo cual nos orienta a buscar signos y síntomas de compromiso de órganos o sistemas posiblemente afectados acercándonos a una medicina personalizada y de precisión.

Introduction: Tuberous sclerosis is a rare disorder with multisystemic clinical manifestations that can compromise vital organs such as the kidney, lung and heart, which requires early diagnosis to provide timely and targeted treatment, improving the prognosis and reducing the morbidity and mortality attributed to these pathologies. Objective: To establish the importance of the use of genomics and the phenotype-genotype correlation for the diagnosis, treatment, follow-up, prognosis, genetic counseling of tuberous sclerosis. Materials and methods : Case report of a 15 year old patient with body angiofibromas, retinal hamartoma, right angiomyolipoma and alterations in neuroimaging studies without seizures or neurobehavioral disorders, clinically suspected of tuberous sclerosis with genetic confirmation by having a pathogenic variant in heterozygosity in the TSC2 gene. Results: A pathogenic heterozygous deletion was found in which a cytosine is changed at position 2539 of the TSC2 gene cDNA (c.2539delC), leading to a premature stop codon at amino acid 893 ( p.Leu847Cysfs*47) into a protein of 1,807 amino acids with pathogenic clinical significance. Conclusions: Tuberous sclerosis complex is an orphan disease for Colombia given the low population prevalence, with a high burden of morbidity and mortality due to multisystem involvement. Its confirmation is performed by molecular-genomic methods that allow establishing phenotype-genotype correlation given the variability in the variants reported in this gene and the different degree of phenotypic expression in individuals, which guides us to look for signs and symptoms of involvement of organs or systems possibly affected, approaching a personalized and precision medicine.

Rabdomioma cardiaco en relación con tetralogía de Fallot y esclerosis tuberosa / Cardiac rhabdomyoma associated with tetralogy of Fallot and tuberous sclerosis

Resumen Los tumores cardiacos son inhabituales en la edad pediátrica; de ellos, el rabdomioma es el más prevalente. Su curso suele ser benigno. Los casos sintomáticos obedecen a su efecto mecánico obstructivo o a la presencia de arritmias. No es común su asociación con cardiopatías congénitas. Se presenta el caso de un lactante con rabdomiomas múltiples dentro del complejo de esclerosis tuberosa y portador de tetralogía de Fallot con estenosis infundibulovalvular grave, quien presentó crisis de hipoxia que requirió valvuloplastia pulmonar percutánea, la cual se complicó por arritmia supraventricular y tuvo un desenlace fatal.

Abstract Cardiac tumors are rare in pediatrics, and when they occur, rhabdomyomas are the most prevalent. They are generally benign; symptomatic cases are due to mechanical obstruction or arrhythmias. They are not commonly associated with congenital heart disease. We present the case of an infant with multiple rhabdomyomas as part of tuberous sclerosis complex, and tetralogy of Fallot with severe infundibular and valvular stenosis, who presented a hypoxic crisis requiring percutaneous pulmonary valvuloplasty which was complicated by supraventricular arrythmia and had a fatal outcome.

Anesthetic management in neurological disorders: is combined spinal-epidural a suitable option? Case report / Manejo anestésico en trastornos neurológicos: ¿es la anestesia espinal-epidural una alternativa apropiada? Reporte de caso

Abstract Tuberous sclerosis (TSC) is a rare disease with multi-systemic involvement, predominantly neurological. Little evidence exists about the anesthetic management of patients with this disorder, particularly in pregnant women. This article discusses a case of a patient with TSC admitted to our hospital for the delivery of a twin gestation. Twenty-four hours after surgery, the patient presented left-side facial-brachial hypoesthesia and headache. A brain CT revealed a right frontal cortical bleeding tumor, which was diagnosed as glioblastoma multiforme. The patient was discharged 15 days after admission and a neurosurgical approach was suggested.

Resumen La esclerosis tuberosa es una enfermedad poco frecuente asociada con compromiso multisistémico, principalmente neurológico. Es poca la evidencia sobre el manejo anestésico de los pacientes con este trastorno, en particular las mujeres embarazadas. En este artículo presentamos el caso de una paciente con esclerosis tuberosa ingresada en nuestro hospital para el parto de una gestación gemelar. Veinticuatro horas después de la cirugía, la paciente presentó hipoestesia facial y braquial izquierda y cefalea. La tomografía cerebral mostró un tumor cortical sangrante en el lóbulo frontal derecho, diagnosticado como glioblastoma multiforme. La paciente fue dada de alta 15 días después de su ingreso y, con recomendación de manejo por neurocirugía.