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Landmark TOSCA Registry Reveals New Insights into Tuberous Sclerosis Complex Management

• The multinational TOSCA registry, encompassing 2,221 TSC patients from 31 countries, has provided crucial data on disease manifestations and treatment patterns in Tuberous Sclerosis Complex.

• Subependymal giant-cell astrocytomas (SEGAs) were found in 25% of patients, with mTOR inhibitors emerging as a primary treatment option alongside surgery for tumor management.

• The study revealed significant associations between TSC2 mutations and more severe disease manifestations, while also highlighting the substantial impact on patients' quality of life and the need for improved transition from pediatric to adult care.

The groundbreaking TuberOus SClerosis registry to increase disease Awareness (TOSCA) has yielded comprehensive insights into the natural history and management of Tuberous Sclerosis Complex (TSC), a multisystem genetic disorder affecting multiple organs through mTOR pathway overactivation.

Key Clinical Findings

The registry's analysis of 2,221 patients revealed that Subependymal giant-cell astrocytomas (SEGAs) affected 25% of participants, with a median diagnosis age of 8 years. SEGAs proved significantly more prevalent in patients with TSC2 mutations compared to TSC1 (33.7% vs. 13.2%, p<0.0001). Notably, these tumors caused symptoms in 42.1% of cases, including increased seizure frequency (15.8%) and cognitive skill deterioration (9.9%).
Treatment patterns showed a paradigm shift, with mTOR inhibitors nearly matching surgical interventions in frequency (49% vs. 59.6%). This trend reflects evolving therapeutic approaches, though researchers note potential bias due to high participation from EXIST-1 trial sites.

Epilepsy and Neurological Manifestations

The registry documented epilepsy in 85% of TSC patients, with many cases proving drug-resistant. TSC1 mutations correlated with milder epilepsy phenotypes and higher rates of normal IQ. GABAergic medications emerged as the primary treatment choice for infantile spasms, prescribed in 45% of affected children.

Treatment Safety and Efficacy

Long-term safety data for everolimus, a key mTOR inhibitor, showed manageable adverse effects. In a post-authorization safety study, 66% of patients experienced adverse events, with stomatitis (7.8%) and headache (7.3%) being most common. Only 5% discontinued treatment due to side effects.

Quality of Life Impact

The TOSCA registry highlighted significant psychosocial burdens on TSC patients and their families. Particularly concerning was the finding that only 36% of caregivers reported smooth transitions from pediatric to adult care, indicating a critical area for healthcare system improvement.

Future Directions

The findings emphasize the need for comprehensive care centers with multidisciplinary teams and dedicated TSC coordinators. Early intervention strategies, particularly for seizure prevention and autism spectrum disorder risk management, have emerged as crucial focus areas for improving patient outcomes.
The registry has successfully enhanced understanding of TSC's natural history and management, while identifying critical areas for future research and healthcare delivery optimization. These insights are expected to drive improvements in early diagnosis, preventive measures, and treatment strategies for TSC patients worldwide.
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Reference News

[1]
Frontiers | Editorial: Tuberous Sclerosis Complex – Diagnosis ...
frontiersin.org · Oct 4, 2021

Tuberous sclerosis complex (TSC) is a genetic disorder affecting multiple organs, with gaps in understanding its pathoge...

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