The Tuberous Sclerosis Complex

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Abstract
We wish to reframe the discussion regarding the neurodevelopmental manifestations of the tuberous sclerosis complex (TSC) in the overview of TSC by Crino et al. (Sept. 28 issue).1 First, the authors state, “Epilepsy may be the most prevalent and challenging clinical manifestation of TSC.” However, patients and caregivers have reported that cognitive and behavioral difficulties are the greatest challenge, over and above epilepsy,2 and they continue to do so. Almost everyone with TSC, even in the absence of epilepsy, has clinically significant cognitive or behavioral problems.3