Ann Neurol. 2022 Nov 16.
TACERN study group
OBJECTIVE: Tuberous Sclerosis Complex (TSC) is associated with focal brain "tubers" and a high incidence of autism spectrum disorder (ASD). The location of brain tubers associated with autism may provide insight into the neuroanatomical substrate of ASD symptoms.METHODS: We delineated tuber locations for 115 TSC participants with ASD (n = 31) and without ASD (n = 84) from the Tuberous Sclerosis Complex Autism Center of Excellence Research Network. We tested for associations between ASD diagnosis and tuber burden within the whole brain, specific lobes, and at eight regions of interest derived from the ASD neuroimaging literature including the anterior cingulate, orbitofrontal and posterior parietal cortices, the inferior frontal and fusiform gyri, the superior temporal sulcus, the amygdala, and the supplemental motor area. Next, we performed an unbiased data-driven voxel-wise lesion symptom mapping (VLSM) analysis. Finally, we calculated the risk of ASD associated with positive findings from the above analyses.
RESULTS: There were no significant ASD-related differences in tuber burden across the whole-brain, within specific lobes, or within a priori regions derived from the ASD literature. However, using VLSM analysis we found that tubers involving the right fusiform face area (FFA) were associated with a 3.7-fold increased risk of developing ASD.
INTERPRETATION: While TSC is a rare cause of ASD, there is a strong association between tuber involvement of the right FFA and ASD diagnosis. This highlights a potentially causative mechanism for developing autism in TSC that may guide research into ASD symptoms more generally. This article is protected by copyright. All rights reserved.