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Poor Mental Development in Patients With Tuberous Sclerosis Complex
Clinical Risk Factors
Sergiusz Jozwiak, MD;
Michael Goodman, MD, MPH;
Steven H. Lamm, MD, DTPH
Arch Neurol. 1998;55:379-384.
Objective To identify clinical risk factors for poor mental development among patients with tuberous sclerosis complex (TSC).
Design Case-control analysis of a clinic population.
Setting Specialty clinic in a hospital.
Patients One hundred six patients with TSC consecutively seen between January 1984 and December 1995 at the Child Neurology Clinic of the Children's Memorial Health Institute in Warsaw, Poland.
Study Variables Seizure type, age at seizure onset, sex, and history of diphtheria, tetanus, and pertussis immunization.
Main Outcome Measure Moderate to profound developmental delays.
Results Seizure type (ie, infantile spasms) was the only analyzed risk factor that showed a consistent and independent association with poor mental development (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.4; P=.03). Age at seizure onset, which initially showed a significant association with poor mental development, was no longer significantly associated after adjustment for seizure type (adjusted odds ratio, 1.6; P=.43). Neither sex (odds ratio, 1.1; P=.96) nor history of diphtheria, tetanus, and pertussis immunization (odds ratio, 1.0; P=.80) showed evidence of being a risk factor for poor mental development among patients with TSC.
Conclusions Infantile spasms, as the type of seizure on initial examination, is a significant risk factor for poor mental development in patients with TSC. Age at time of first seizure is not an independent risk factor but reflects the early ages at which these patients are seen with infantile spasms. Neither sex nor history of diphtheria, tetanus, and pertussis immunization is a risk factor for the subsequent development of poor mental development among patients with TSC.
From the Department of Neurology, Children's Memorial Health Institute, Warsaw, Poland (Dr Jozwiak); and Consultants in Epidemiology and Occupational Health Inc, Washington, DC (Drs Goodman and Lamm).
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