Self-injurious behavior and tuberous sclerosis complex: Frequency and possible associations in a population of 257 patients

Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
Epilepsy & Behavior (Impact Factor: 2.26). 09/2008; 13(4):650-3. DOI: 10.1016/j.yebeh.2008.07.010
Source: PubMed


Self-injurious behavior (SIB) has been observed in people with tuberous sclerosis complex (TSC), although the frequency of SIB in TSC is largely unknown. SIB is associated with intellectual and developmental disabilities, but there is no single cause of SIB. We retrospectively examined the frequency of SIB in a population of 257 patients with TSC and determined possible associations with SIB. We found a 10% frequency of SIB in our TSC population. When compared with patients without psychiatric symptoms, we identified a significantly higher rate of electroencephalographic interictal spikes in the left frontal lobe and a significantly lower number of tubers in the left occipital, parietal, and posterior temporal lobes. We also found that frequency of TSC2 mutation, history of infantile spasms, history of seizures, mental retardation, and autism are significantly associated with SIB.

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    • "High rates of aggression (13.3% to 58%) [8-10] and self-injury (10% to 41%) [8,10,11] have been reported in people with TSC. However, to date, the rates of self-injurious and aggressive behaviour have not been compared with those reported in other syndrome groups and individuals with ID. "
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    ABSTRACT: Research reporting prevalence rates of self-injurious and aggressive behaviour in people with tuberous sclerosis complex (TSC) is limited. No studies have compared rates of these behaviours in TSC with those in other syndrome groups matched for degree of disability or investigated risk markers for these behaviours in TSC. Data from the Challenging Behaviour Questionnaire were collected for 37 children, aged 4 to 15 years, with TSC. Odds ratios were used to compare rates of self-injury and aggression in children with TSC with children with idiopathic autism spectrum disorder (ASD), fragile X, Cornelia de Lange and Down syndromes. Characteristics were measured using the Mood Interest and Pleasure Questionnaire, the Activity Questionnaire, the Social Communication Questionnaire, the Repetitive Behaviour Questionnaire, the Wessex Behaviour Schedule and the revised Non-communicating Children Pain Checklist. Mann-Whitney U analyses were used to compare characteristics between individuals with self-injury and aggression and those not showing these behaviours. Rates of self-injury and aggression in TSC were 27% and 50%, respectively. These are high but not significantly different from rates in children with Down syndrome or other syndrome groups. Both self-injury and aggression were associated with stereotyped and pain-related behaviours, low mood, hyperactivity, impulsivity and repetitive use of language. Children who engaged in self-injury also had lower levels of interest and pleasure and showed a greater degree of 'insistence on sameness' than children who did not self-injure. Aggression was associated with repetitive behaviour. The majority of these associations remained significant when the association with level of adaptive functioning was controlled for. Behavioural profiles can be used to identify those most at risk of developing self-injury and aggression. Further research is warranted to understand the influence of such internal factors as mood, ASD symptomatology and pain on challenging behaviour in people with intellectual disability.
    Full-text · Article · May 2014 · Journal of Neurodevelopmental Disorders
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    • "In our center, epilepsy in TSC proved refractory to medical treatment in approximately two-thirds of individuals. The presence of refractory epilepsy and infantile spasms in TSC has been shown to be significantly associated with cognitive impairment, autism spectrum disorders, and psychiatric disorders, including self injurious behaviors (O'Callaghan et al., 2004; Winterkorn et al., 2007; Staley et al., 2008). Infantile spasms occur more commonly in those with TSC2 mutations, consistent with the finding that TSC2 mutations are usually associated with a more severe phenotype than TSC1 mutations (Dabora et al., 2001; Muzykewicz et al., 2009). "
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    ABSTRACT: Epilepsy is very common in tuberous sclerosis complex and occurs in 80 to 90% of affected individuals during their lifetime. Onset usually occurs during childhood, and up to one third of children with tuberous sclerosis complex will develop infantile spasms. Although not completely understood, the incidence of epilepsy is thought to relate to the neuropathologic features of the disorder, including cortical tubers and other dysgenetic features. Individuals with tuberous sclerosis complex frequently have epileptiform features to their electroencephalograms. Treatment of epilepsy in tuberous sclerosis complex is similar to epilepsy resulting from other causes and includes anticonvulsant medications, the vagus nerve stimulator, and the ketogenic diet. Vigabatrin has been shown to be particularly effective in treating infantile spasms in the setting of tuberous sclerosis complex. Epilepsy surgery has a very important role in the management of children and adults with pharmacoresistant epilepsy in tuberous sclerosis complex.
    Preview · Article · Feb 2010 · Epilepsia
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    • "Infantile spasms, a form of early childhood epilepsy, are diagnosed in ~50% (Webb et al. 1996; Joinson et al. 2003). In adulthood, psychiatric features, including depression, anxiety, self-injurious behaviours and high levels of psychological distress, are also frequently encountered (Raznahan et al. 2006, Muzykewicz et al. 2007; Pulsifer et al. 2007; Staley et al. 2008). "
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    ABSTRACT: Tuberous sclerosis (TSC) is a multi-system disorder caused by heterozygous mutations in the TSC1 or TSC2 gene and is often associated with neuropsychiatric symptoms, including intellectual disability, specific neuropsychological deficits, autism, other behavioural disorders and epilepsy. Here, we review evidence from animal models of TSC for the role of specific molecular and cellular processes in the pathogenesis of cognitive, developmental and epilepsy-related manifestations seen in the disorder. Recent evidence shows that, in animal models, disinhibited mTOR (mammalian target of rapamycin) signalling substantially contributes to neuropsychiatric phenotypes, including cognitive deficits and seizures. We discuss potential pathogenetic mechanisms involved in the cognitive phenotypes of TSC and present implications regarding mTOR inhibitor-based treatments for TSC-related neuropsychiatric features. Results suggest that reversing the underlying molecular deficits of TSC with rapamycin or other mTOR inhibitors could result in clinically significant improvements of cognitive function and neurological symptoms, even if treatments are started in adulthood.
    Full-text · Article · Sep 2009 · Journal of Intellectual Disability Research
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