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Journal of Child Neurology
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Intrafamilial Phenotypic Variability in Tuberous Sclerosis Complex

David A. Lyczkowski, MA

Department of Neurology, Massachusetts General Hospital

Kerry D. Conant, BA

Department of Neurology, Massachusetts General Hospital

Margaret B. Pulsifer, PhD

Department of Psychiatry, Massachusetts General Hospital

Delma Y. Jarrett, MD

Department of Radiology Massachusetts General Hospital

P. Ellen Grant, MD

Department of Radiology Massachusetts General Hospital

David J. Kwiatkowski, MD, PhD

Genetics Laboratory Division of Translational Medicine, Brigham and Women's Hospital, Boston, Massachusetts

Elizabeth A. Thiele, MD, PhD

Department of Neurology, Massachusetts General Hospital, ethiele{at}partners.org

Clinical manifestations were retrospectively assessed in 5 families with tuberous sclerosis complex, including 1 pair of monozygotic twins. Interfamilial variation in tuber count was significantly larger than intrafamilial variation. Severity of epilepsy and cognitive profiles varied both between and within families, particularly between the monozygotic twins, and IQ was inversely related to tuber count. Cutaneous, renal, and cardiac findings did not appear to cluster within families. Although the monozygotic twins displayed similar physical manifestations of tuberous sclerosis complex (renal and cardiac hamartomas), they differed markedly in neurocognitive profiles. Phenotypic variation within these families may be explained largely as a function of the randomness of second-hit events that cause hamartomas in tuberous sclerosis complex or by as-yet-unidentified genetic modifiers. Familial variation in tuberous sclerosis complex phenotype has important implications for genetic counseling.

Key Words: tuberous sclerosis complex • phenotypic variation • monozygotic twins

Journal of Child Neurology, Vol. 22, No. 12, 1348-1355 (2007)
DOI: 10.1177/0883073807307093
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