Abstract
BackgroundTuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder associated with mutations in TSC1 and TSC2 genes, upregulation of mammalian target of rapamycin signaling, and subsequent tumor formation in various organs. Due to the many manifestations of TSC and their potential complications, management requires the expertise of multiple medical disciplines. A multidisciplinary care approach is recommended by consensus guidelines. Use of multidisciplinary teams (MDTs) has been shown to be beneficial in treating other complex diseases, such as cancer. In a lifelong disease such as TSC, an MDT may facilitate the transition from pediatric to adult care. However, little guidance exists in the literature regarding how to organize an MDT in TSC.MethodsTo discuss the best approach to assembling an MDT, this project was initiated in October 2017 with a meeting of 12 physicians from various specialties and various countries. Following this first meeting, the experts generated statements on the most important aspects to implement in establishing an MDT for TSC by 3 rounds of selection using a Delphi process via electronic correspondence. Finally, TSC patient advocates reviewed the findings and provided additional insights from a patient perspective.ResultsA 3-step roadmap was recommended, starting with identifying a single individual to begin organizing care (Step 1), then establishing a small core team (Step 2), and finally, establishing a larger multi-disciplinary team (Step 3). Because of the multisystemic nature of TSC, the MDT should include specialists such as a neurologist, a neurosurgeon, a nephrologist, a urologist, a pulmonologist, an ophthalmologist, a cardiologist, a dermatologist, a geneticist, and a psychiatrist/psychologist. The MDT should recommend a care plan for each patient based on the individual’s needs and in consultation with him/her or his/her family. Some of the most important aspects of an MDT that were agreed upon included identifying a case manager to help coordinate care, providing access to health care professionals of varying specialties, and including a lead physician who takes medical responsibility for patients’ overall care.ConclusionsThe results of our consensus provide guidance to support the initiation of an MDT in TSC.
Highlights
Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder associated with mutations in TSC1 and TSC2 genes, upregulation of mammalian target of rapamycin signaling, and subsequent tumor formation in various organs
Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder occurring in 1 in 6000 live births [1, 2]. It is caused by mutations in either the TSC1 or TSC2 gene, which result in upregulation of the mammalian target of rapamycin pathway and subsequent tumor growth in various organs such as the brain, heart, skin, eyes, kidney, lung, and liver [2, 3]
Organizing a multidisciplinary care team for the management of TSC Three steps were identified by the task force/group (Table 1)
Summary
Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder associated with mutations in TSC1 and TSC2 genes, upregulation of mammalian target of rapamycin signaling, and subsequent tumor formation in various organs. Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder occurring in 1 in 6000 live births [1, 2] It is caused by mutations in either the TSC1 or TSC2 gene, which result in upregulation of the mammalian target of rapamycin (mTOR) pathway and subsequent tumor growth in various organs such as the brain, heart, skin, eyes, kidney, lung, and liver [2, 3]. Cardiac rhabdomyomas can develop prenatally and are one of the earliest detectable signs of TSC [2, 5] They are usually asymptomatic and regress with age, these lesions occasionally cause arrhythmias and lead to ventricular dysfunction and may require consultation with a cardiologist [2, 5]. Because skin lesions are prominent manifestations that can be visible at a young age, dermatologists are in a position to identify TSC early in the disease course [7]
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