Reach Out October 2019
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<strong>Reach</strong><br />
<strong>Out</strong><br />
OCTOBER <strong>2019</strong> ISSUE 110<br />
TSC Connect<br />
p8<br />
Our new<br />
nurse p6<br />
Research<br />
updates<br />
p17-20<br />
www.tsa.org.au
TSA News<br />
Contents<br />
Editorial................................................................................................. 3<br />
President’s Report................................................................................. 4<br />
Six Months In ....................................................................................... 5<br />
Communities Connecting for TSC Global<br />
Awareness Day <strong>2019</strong>............................................................................14<br />
Connecting with Other Organisations.............................................16<br />
Connecting Through Technology ..................................................... 6<br />
Welcome Kim........................................................................................ 7<br />
TSC Connect, Brisbane........................................................................ 8<br />
The Value of Connections................................................................... 9<br />
Our Financial Results..........................................................................10<br />
EPISTOP: International Research Results on Epilepsy...................17<br />
Research News.....................................................................................18<br />
Australian Families’ Experience with a TSC Diagnosis................. 20<br />
Congratulations to Dr Fiona McKenzie............................................21<br />
The Impact of your Support.............................................................. 13<br />
Snapshot............................................................................................... 22<br />
Our cover image is of participants at the TSC Connect event in Brisbane in May <strong>2019</strong>.<br />
Tuberous Sclerosis Complex<br />
(TSC) affects more than 2000 individuals in<br />
Australia and thousands more carers, families and friends<br />
who live with the impact of the disease.<br />
TSC tumours can grow in any organ of the body, commonly affecting<br />
the brain, skin, heart, lungs and kidneys. TSC can cause epilepsy,<br />
developmental delay and autism. There is no known cure for TSC, but<br />
with appropriate support most people with TSC can live fulfilling lives.<br />
Tuberous Sclerosis Australia<br />
Works to connect, inform and empower people affected by tuberous<br />
sclerosis complex as we work towards a cure for TSC.<br />
TSA was established in 1981 as a volunteer organisation to connect families<br />
living with TSC. We have hundreds of members including people with TSC and<br />
their families along with health, education and caring professionals.<br />
Our priorities<br />
1. Ensure Australians with TSC have access to the best possible healthcare<br />
2. Provide up to date and accurate information to all Australians with TSC<br />
3. Support individuals and families affected by so no one has to face the<br />
challenges of TSC alone<br />
4. Promote access in Australia to the gobal research program that is working<br />
towards a cure for TSC<br />
President Debbie Crosby<br />
Vice President Michelle Purkiss<br />
Committee Member<br />
Treasurer Patrick Norris<br />
Secretary Alison McIvor<br />
Michael Jones<br />
Public Officer Debbie Crosby<br />
Medical Advisory Board Dr David Mowat,<br />
Clinical Geneticist<br />
General Manager<br />
Fundraising and<br />
Communications<br />
Dr John Lawson,<br />
Paediatric Neurologist<br />
Dr Sean Kennedy<br />
Paediatric Nephrologist<br />
Jackie Gambrell<br />
Kate Garrard<br />
The TSC Information Service<br />
Visit our website for extensive information about TSC for individuals, their families<br />
and professionals www.tsa.org.au<br />
Call or email us to speak to one of our volunteers. We have regional contacts throughout<br />
Australia who can meet face to face and connect you with local services. 1300 733 435<br />
TSA Nurse<br />
This is a free, confidential information and support service for those in Australia. You can speak<br />
with our Nurse about any TSC-related questions or concerns you have. Email nurse@tsa.org.au<br />
Not in Australia or New Zealand?<br />
TSA is a founding member of Tuberous Sclerosis Complex International, a<br />
worldwide association of TSC organisations. The TSCi website contains<br />
a directory of TSC organisations around the world<br />
www.tscinternational.org<br />
2<br />
<strong>Reach</strong><br />
<strong>Out</strong><br />
OCTOBER <strong>2019</strong> ISSUE 110
TSA News<br />
Editorial<br />
Teresa Llewellyn-Evans<br />
Welcome to the <strong>October</strong> <strong>2019</strong> issue<br />
of <strong>Reach</strong> <strong>Out</strong>. This issue highlights<br />
the importance of connections. My<br />
son David had Hunter syndrome or<br />
Mucopolysaccharidosis type 2 (MPS II)<br />
and some of my closest friendships have<br />
come from a shared experience of MPS and<br />
with those who supported us on our journey.<br />
You too might make lasting connections with<br />
like-minded people by engaging with the<br />
TSC community.<br />
Tuberous Sclerosis Australia (TSA) was established in 1981 as<br />
a volunteer organisation to connect families living with tuberous<br />
sclerosis complex (TSC). And today TSA still works to connect,<br />
inform and empower people affected by TSC as we work towards<br />
a cure for TSC.<br />
A diagnosis of tuberous sclerosis can be very isolating.<br />
Connecting with others can provide support and help break<br />
down this feeling of isolation. Debbie Crosby describes it in the<br />
following way in her president’s report on page 4: “…connections<br />
with others…are so vitally important when facing the challenges<br />
of life with TSC…it often helps me remember that my family is<br />
not the only one going through these challenges.”<br />
Connecting is important at all stages of life. Read about our<br />
first ever TSC Connect event for adults living with TSC held in<br />
Brisbane in May and Penny McKee’s reflection on this event on<br />
pages 8-9.<br />
Members of our TSC community can also connect through<br />
our closed Facebook group, which is only open to those affected<br />
by TSC. Find out more on page 9.<br />
TSA’s new nurse service will make<br />
connecting to the support and information<br />
you need even easier. Kim will be able to<br />
support you with information, links to<br />
practical support and help you to live well<br />
with TSC. Read more about the service and<br />
Kim on pages 6-7.<br />
Our Celebrations section highlights the<br />
many ways our TSC community connected for<br />
TSC Global Awareness Day on 15 May this year. Read<br />
more about pyjama days in Tasmania, morning teas in<br />
Victoria, dinners in Perth and online Facebook campaigns, as well<br />
as many people taking selfies wearing their wave tattoos on pages<br />
14-15.<br />
Our fundraising snapshot highlights some of the wonderful<br />
ways our TSC community connects to raise much needed funds for<br />
TSA including entertainment evenings, lunches, appeals, grants,<br />
memberships, TSC Hero events and more (see pages 22-23).<br />
Connecting with other rare disease and patient organisations<br />
to share expertise and knowledge is also important. Jackie, our<br />
new General Manager, describes two recent events where TSA<br />
connected with 100 charities across Australia at the inaugural<br />
Australian Patient Organisation Network (APON) Conference in<br />
Sydney, and with 25 international TSC patient associations at the<br />
TSC International Research Conference in Toronto. Read more<br />
about this on page 16.<br />
And, of course, we will continue to connect you to the latest<br />
local and international TSC research. You will find this on pages<br />
17-20.<br />
Enjoy!<br />
<strong>Reach</strong> <strong>Out</strong> Official Journal of Tuberous Sclerosis<br />
Australia, Inc.<br />
18 Central Rd, Beverly Hills NSW 2209<br />
Telephone: 1300 733 435<br />
Website: www.tsa.org.au<br />
Email: info@tsa.org.au<br />
ABN 20 681 174 734<br />
Incorporation no. Y 07116-42<br />
Registered Charity CC25313<br />
<strong>Reach</strong> <strong>Out</strong> Editor: Teresa Llewellyn-Evans<br />
Disclaimer<br />
The opinions expressed in this journal are those of the<br />
authors and are not official pronouncements of TSA Inc.<br />
Permission<br />
Permission must be sought from the authors or publishers<br />
to reproduce in any way articles or information contained<br />
in this journal. Once permission is received the source must<br />
be acknowledged.<br />
3
TSA News<br />
President’s Report<br />
Debbie Crosby, President<br />
Welcome to our <strong>October</strong> <strong>2019</strong> issue<br />
of <strong>Reach</strong> <strong>Out</strong>. Connections is<br />
the theme for this issue and so it is very<br />
fitting that our first ever TSC Connect<br />
event for adults living with TSC was held<br />
in Brisbane in May. It was wonderful to<br />
meet everyone and share personal stories<br />
and information. I thank you for your<br />
passion and commitment and I’m sure<br />
some strong and lasting connections were<br />
made among the group. Thanks also to<br />
Nikky Isbel, Consultant Nephrologist at<br />
Princess Alexandra Hospital, and Megan<br />
Higgins, Clinical Geneticist with Genetic<br />
Health Queensland, who generously gave<br />
up their weekend to present to the group.<br />
As a community we are fortunate to have<br />
such committed health professionals<br />
working alongside us.<br />
I would also like to thank our new<br />
General Manager, Jackie Gambrell, who<br />
hit the ground running and organised<br />
this fantastic event. Jackie has been very<br />
busy since joining TSA and, as all of you<br />
know, TSC is such a complex disease to<br />
understand and there is so much to learn.<br />
It has been an exciting time to have her<br />
join the organisation, as we improve and<br />
grow our services.<br />
In June this year we held our biggest<br />
Lizzie’s Lunch event, with over 120<br />
people connecting for our cause. It was a<br />
fabulous day with Master of Ceremonies<br />
Ron Wilson, and we raised more than<br />
$22,000 for TSA. Once again, we are<br />
indebted to Sue Pinkerton and her<br />
amazing family and friends for making<br />
this event happen. Sue, you just keep<br />
rising to the challenge to make it bigger<br />
and better every year!<br />
I’m really looking forward to our<br />
next major fundraiser, Comedy for a<br />
Cure, in Sydney. We have a top class line<br />
up of comedians so, if you haven’t yet<br />
got your tickets then you’d better hurry.<br />
It’s sure to be a fabulously funny night.<br />
Again, thanks to the team who have been<br />
working tirelessly to make this happen,<br />
in particular, Rob McHugh, Kate Garrard<br />
and Michelle Purkiss.<br />
Connections with<br />
others – be it family,<br />
friends or members of our<br />
community - are so vitally<br />
important when facing<br />
the challenges of life with<br />
TSC…It often helps me<br />
remember that my family<br />
is not the only one going<br />
through these challenges.<br />
It is with sadness, but understanding,<br />
that we’ve seen two of our TSA committee<br />
members stand down in the last six<br />
months to focus on other personal<br />
priorities. Kate Veach and Georgie Schilg,<br />
both mothers of children with TSC,<br />
contributed an enormous amount during<br />
their time on the committee and we thank<br />
them both. Ensuring the committee is<br />
represented by people living with TSC<br />
or have a TSC connection is important<br />
and assists us to ensure TSA continues to<br />
support the TSC community successfully.<br />
As we all know, connections with<br />
others – be it family, friends or members<br />
of our community - are so vitally<br />
important when facing the challenges<br />
of life with TSC. Personally, as a mother<br />
of a child with TSC, I find speaking to<br />
or hearing from others who have gone<br />
through the same or similar experiences<br />
very helpful. Importantly, it often helps<br />
me remember that my family is not the<br />
only one going through these challenges.<br />
TSA is committed to connecting<br />
with all those whose lives are affected by<br />
TSC. In 2020 we are planning another<br />
connect event for families and adults from<br />
around Australia who are living with TSC<br />
as well as members of our TSC health<br />
professionals community. We’re also<br />
thankful for the financial support from<br />
Lotterywest for a planned TSC event in<br />
Perth next year.<br />
We look forward to continuing to<br />
connect with you to share your stories<br />
and information. I’d like to thank<br />
the continuing members of the TSA<br />
committee – Michael Jones, Alison<br />
McIvor, Patrick Norris and Michelle<br />
Purkiss – who volunteer their time and<br />
always do such great work. Let’s keep<br />
connecting!<br />
4<br />
<strong>Reach</strong><br />
<strong>Out</strong><br />
OCTOBER <strong>2019</strong> ISSUE 110
TSA News<br />
Six Months In<br />
Jackie Gambrell, General Manager<br />
My first six months as TSA’s new General Manager have<br />
been very rewarding and wonderfully diverse. I’d like to<br />
thank everyone for the very warm welcome they’ve given me.<br />
It’s been a busy time with visits to Sydney Children’s Hospital,<br />
speaking at Baker McKenzie on Global Awareness Day, a trip to<br />
an international conference and forming connections with other<br />
rare disease, patient and genetics associations.<br />
The undoubted highlights though were attending Lizzie’s<br />
Lunch and meeting so many of you, our wonderful community,<br />
and spending time with attendees at our TSC Connect event in<br />
Brisbane. I’m really looking forward to running and attending<br />
more events like these. I hope to see many of you at Sydney’s<br />
Comedy for a Cure on Saturday 26 <strong>October</strong>.<br />
Six months in, I find myself starting to ask lots of questions,<br />
such as:<br />
• What other information and support does our community<br />
need and want?<br />
• How do we ensure everyone in Australia living with TSC<br />
knows about us and has access to our information and<br />
support?<br />
• Can we promote the benefits of the TSC clinic approach with<br />
the hope of establishing one in every state and territory?<br />
• How can we ensure the best possible network of health<br />
professionals with TSC expertise throughout Australia?<br />
• What can we do to support health professionals here<br />
and internationally investigate and research the full potential<br />
of mTOR inhibitors and other treatments that might lead to a<br />
cure for TSC?<br />
One thing’s for sure. TSA and I need your help. TSA exists for<br />
you and we need to know what you think and want. This is why<br />
we are asking you to complete our <strong>2019</strong> survey. We will of course<br />
share the outcomes of the survey with you. Together, I’m confident<br />
we can both ask and answer the big questions. Please complete the<br />
survey today! Thank you for your help.<br />
Help Us to Help You<br />
TSA is launching an online survey to find out more about you, our<br />
TSC community. Your feedback will help us focus our efforts and<br />
further improve our services, communications and fundraising.<br />
Your responses will be kept private and confidential, as already happens with all the personal<br />
information you share with TSA. The survey is available at: https://www.tsa.org.au/survey<br />
What are we asking you and why?<br />
One of our goals for 2020 is to expand our TSC Health Professionals Network. So, in this year’s<br />
survey we ask you to tell us about your GP and your health professional team.<br />
We also want your views and input on current and future services – newsletters, online forums,<br />
events, education resources and the TSA website – to find out how well we are connecting you to<br />
the support and information you need.<br />
Please Help Us to Help You. Go online and complete the TSA survey today.<br />
www.tsa.org.au/survey<br />
5
TSA News<br />
Connecting Through<br />
Technology<br />
TSA’s new nurse service<br />
Everyone at TSA is excited to welcome our new nurse, Kim Kerin-Ayres. The addition of a<br />
qualified nurse to our team is a significant one. TSA’s new nurse service is a free, confidential<br />
information and support service to support you with information, links to practical support<br />
and to help you live well with TSC. Kim is committed to helping the TSC community and will<br />
work hard to find answers to your many and varied questions. She will be working closely with<br />
and supported by members of our TSC health professionals network around the country and<br />
our regional volunteers who know what it is like to live with TSC.<br />
Kim can help you with any questions and/or concerns you may have about TSC, including:<br />
• emotional support if you or someone you care about has TSC<br />
• questions you may have about TSC, including about tests and medical procedures<br />
• pathways for navigating the health system<br />
• how to find other organisations and resources that can help you in your life with TSC.<br />
Kim will also be able to help adults with TSC develop a personal care plan based on the TSC<br />
surveillance guidelines.<br />
Kim is available by appointment on Wednesdays and Fridays each week. You can book an<br />
appointment by emailing nurse@tsa.org.au<br />
TSA is grateful to the Centre for Community-Driven Research (CCDR) for making it possible<br />
for us to have our very own nurse. Kim has been appointed as part of the Patient Pathways Pilot<br />
Program developed by CCDR. The aim of the pilot project is to increase the capacity of patient<br />
organisations, like TSA, to support patients to navigate the health system and access all that is<br />
available to them, including clinical trials.<br />
Patient Pathways is being funded by the Australian Department of Health.<br />
Do you know and<br />
implement the TSC clinical guidelines?<br />
Check them out online at:<br />
https://tsa.org.au/information/guidelines-tsc/<br />
Have you recently completed a<br />
TAND assessment with your clinician?<br />
Find the checklist online at:<br />
https://tsa.org.au/wp-content/uploads/2015/02/TAND_checklist-2014.pdf<br />
To book an<br />
appointment with<br />
Kim email<br />
nurse@tsa.org.au<br />
6<br />
<strong>Reach</strong><br />
<strong>Out</strong><br />
OCTOBER <strong>2019</strong> ISSUE 110
TSA News<br />
Welcome Kim<br />
We are delighted<br />
to welcome Kim<br />
Kerin-Ayres who is TSA’s<br />
new part-time nurse.<br />
Kim is a Clinical<br />
Nurse Consultant and<br />
has worked in a variety of<br />
roles within the healthcare<br />
system for 30 years. Her<br />
work experience includes both<br />
health settings and not-for-profit<br />
environments. Kim has unique<br />
experience working with a telephonebased<br />
helpline where she was<br />
responsible for responding<br />
to inquiries from patients,<br />
health professionals and the<br />
general public for clinical and<br />
supportive care information.<br />
According to Kim, one of<br />
the advantages of telehealth is<br />
its accessibility to everyone. “It<br />
doesn’t matter where you live, or how<br />
far you are from a major city or hospital.<br />
Telehealth means anyone who has a phone connection can get<br />
help and support.”<br />
As Kim says: “Health systems are complex and people<br />
experience evolving informational and supportive care needs<br />
along the way.”<br />
For Kim, a critical aspect of her role is ‘sign-posting’ and<br />
directing people to the resources and support they need, whilst<br />
empowering them to take an active role in managing their<br />
complex condition. “I have broad experience of supporting people<br />
and managing the impact and implications a condition has for<br />
individuals as well as family and friends. I also have extensive<br />
experience developing educational resources for health professionals<br />
and developing and delivering workshops and conferences.”<br />
Kim, a mother of two boys, is currently spending time with<br />
other TSC-related health professionals, such as the team at<br />
Sydney Children’s Hospital and Epilepsy Action Australia and is<br />
grateful for their time and support. She has also connected with<br />
the nurse network at TS Alliance in the US so that TSA can learn<br />
from their experiences.<br />
“I’m really excited to be working with the TSC community and<br />
look forward to speaking with many of you in the coming months.”<br />
<strong>Reach</strong> out to Kim if you have a question or concern. You can<br />
book an appointment by emailing nurse@tsa.org.au<br />
It doesn’t matter where you live, or how far you are<br />
from a major city or hospital. Telehealth means anyone who<br />
has a phone connection can get help and support.<br />
7
TSA News<br />
TSC Connect,<br />
Brisbane<br />
First Connect Event for Adults<br />
TSA held its first TSC Connect event for adults in<br />
Brisbane on 25 May this year. The purpose was to<br />
connect adults living with TSC, provide them with<br />
up-to-date health information and give them an<br />
opportunity to share their experiences.<br />
The day kicked off with two excellent presentations.<br />
Firstly, the group discussed kidney health with Nikky Isbel,<br />
Consultant Nephrologist at Princess Alexandra Hospital and<br />
Associate Professor Medicine at The University of Queensland.<br />
Nikky answered every question posed to her and one participant<br />
was fortunate to connect with their new specialist!<br />
Megan Higgins, Clinical Geneticist with Genetic Health<br />
Queensland, then talked about the genetic issues associated with<br />
TSC and the genetic testing options available.<br />
Nikky Isbel<br />
their experiences of living with TSC or supporting someone with<br />
TSC. Participants shared diagnosis stories, symptoms, experiences<br />
of the health system and the benefit of having a GP who takes<br />
a holistic view and considers what might or might not be TSCrelated.<br />
The groups found many similarities in their stories.<br />
Everyone agreed that it was good to get together as a group of<br />
Participants<br />
shared diagnosis<br />
stories, symptoms,<br />
experiences of the<br />
health system and the<br />
benefit of having a GP<br />
who takes a holistic<br />
view...!<br />
Discussion group<br />
All participants agreed that these sessions were very<br />
worthwhile and had improved their understanding of TSC.<br />
We thank Nikki and Megan for making their expertise<br />
available to us and giving up their valuable weekend time.<br />
We are fortunate indeed to have such<br />
health professionals working<br />
with our community.<br />
In the afternoon<br />
smaller groups shared<br />
Even<br />
though I am<br />
in my forties,<br />
I’d never met<br />
anyone with TSC before.!<br />
Gwen<br />
adults living with TSC and some strong, and hopefully lasting,<br />
connections were made.<br />
Participants also suggested the need for more information on<br />
managing an emergency away from home, managing the mental<br />
health impacts of TSC, and negotiating the NDIS. Participants<br />
said they would love TSA to run more of these<br />
TSC Connect events on a regular basis across Australia.<br />
The day concluded with a guided mindfulness session and<br />
a slow and mindful walk around the beautiful courtyard at the<br />
Translational Research Institute where the event was held.<br />
It was a perfect end to a positive and productive day.<br />
TSA would like to acknowledge the support of the Department of<br />
Social Services in providing financial assistance to help participants<br />
to attend this event.<br />
8 <strong>Reach</strong><br />
OCTOBER <strong>2019</strong> ISSUE 110<br />
<strong>Out</strong>
TSA News<br />
The Value of Connections<br />
Penny McKee, NSW<br />
Penny McKee from regional NSW was one of the participants<br />
at the Brisbane Connect event for adults living with TSC.<br />
In this Q&A, Penny explains why she attended and her experience<br />
of the weekend.<br />
The value of attending was to<br />
‘connect’ in its truest sense -<br />
connect with others and connect<br />
with the latest information - and<br />
hear TSC stories…These connections<br />
are vital for people living with rare<br />
and progressive conditions.<br />
What made you sign up for the event?<br />
Signing up to attend the TSC Connect Weekend in Brisbane was a no<br />
brainer. Having attended the Melbourne TSC Family Day two years ago,<br />
the value of attending was to ‘connect’ in its truest sense - connect with<br />
others and connect with the latest information - and hear TSC stories.<br />
It costs a lot to travel from regional NSW to Brisbane for a weekend<br />
away. The assistance offered to me by TSA, through the NDCI grant<br />
funding, removed this financial barrier.<br />
And lastly, it was time to find out more about TSC. TSC issues have<br />
always been lurking but the leading role for the last ten years has been<br />
played by lymphangioleimyomatosis (LAM) which is a lung condition<br />
associated with TSC. Recent recurring migraines and genetic issues of<br />
the past had resurfaced, and it was time to find out more.<br />
Did the event meet your expectations?<br />
Yes. The information was relevant and real. It was presented like a<br />
seminar which meant there was plenty of time for questions and<br />
answers.<br />
What did you learn?<br />
I learnt about genetic testing which is territory my family and I will<br />
be exploring with our two children. They are symptom free of TSC so<br />
far and have not yet been tested. However, if they do have TSC, they<br />
could develop LAM later in life and I’m keen to ensure they have early<br />
medical surveillance for this.<br />
Did the event help you connect with others living with<br />
TSC?<br />
Most definitely! This weekend was about adults living with TSC and,<br />
among others, I met another TSC lady who had just been diagnosed<br />
with LAM. These connections are vital for people living with rare and<br />
progressive conditions.<br />
Thank you TSA. I was most grateful to be able to attend the TSC<br />
Connect weekend.<br />
Connect with others on our closed Facebook group<br />
TSA has a closed group on Facebook which is only open to those affected by TSC.<br />
It is a wonderful forum for sharing your experiences of living with TSC and finding out about<br />
other people’s experiences. It’s a place where you can ask questions or just read about the<br />
experiences of others. It’s a great source of knowledge.<br />
Recent discussions have included:<br />
• How to get travel insurance<br />
• Side effects of treatments<br />
• National disability insurance<br />
scheme<br />
• Triggers for seizures<br />
• Lymphangioleimyomatosis (a lung<br />
condition associated with TSC)<br />
• How to explain TSC to children.<br />
If you’d like to join, please go to Facebook and search for the group: “Discussions of Tuberous Sclerosis in Australia and New Zealand”.<br />
9
TSA News<br />
Our Financial<br />
Results<br />
Patrick Norris, TSA Treasurer and grandfather of Liam<br />
Patrick Norris<br />
In response to feedback from our members about good<br />
environmental practice, we are no longer automatically<br />
sending all our members a paper copy of TSA’s Annual<br />
Report. We wish, however, to make sure that everything we<br />
do is still transparent and that we are accountable to you, our<br />
community. We are therefore including our headline financials<br />
for the 2018/<strong>2019</strong> Financial Year in this issue of <strong>Reach</strong> <strong>Out</strong>. If<br />
you would like to see the full Annual Report, it is available<br />
online at www.tsa.org.au/annual-reports/ or, if you would<br />
like to receive a paper copy, simply send an email request to<br />
info@tsa.org.au<br />
This has been a year of change for TSA with the departure<br />
of our inaugural General Manager. To facilitate a smooth<br />
handover, this change in management entailed investment in a<br />
period of transition for the team and so we finished the year<br />
with a small deficit of $12,159.<br />
It has also been a year where our growth strategy and our<br />
deliberate decision to invest in fundraising and development<br />
activities has reaped rewards and we saw a significant uplift in<br />
income. We have also moved from an organisation that was<br />
predominately volunteer run to now boasting a team of three<br />
dedicated, part-time paid employees, including, thanks to grant<br />
funding, our new nurse. We have had a dramatic increase in<br />
securing grant monies. Because these grants are typically tied to<br />
specific expenditure, we do not recognise these funds as income<br />
until expended.<br />
Our bookkeeping partners, Refuge Accounting, continue to<br />
ensure that we are compliant in payroll, superannuation and GST.<br />
We use the Xero cloud-based accounting package which provides<br />
secure multi-user access for employees, bookkeepers, committee<br />
members and auditors. All invoices, receipts and documentation<br />
are stored inside Xero, facilitating transparency and auditability.<br />
We also use the CommBiz business banking platform which<br />
requires double authorisation for all payments. Any two of the<br />
President, the Secretary and myself are permitted to authorise.<br />
Our investment policy remains conservative. We invest solely<br />
in term deposits currently across Macquarie Bank and Bank of<br />
Queensland. The maturity dates of our deposits are staggered<br />
through the year so that we always have funds coming available to<br />
aid cashflow. At all times, we aim to keep enough cash available to<br />
meet payroll requirements for the next three months.<br />
The accounts for 2018/19 were audited by Mark Mortimer<br />
(Registered Auditor No. 1942) of Bondy Mortimer & Co. A copy of<br />
his report is available at https://tsa.org.au/about-us/annual-reports/<br />
Building upon our strong<br />
foundations will help us<br />
ensure we will be around<br />
for the long-term ... so every<br />
family and person living with<br />
this disease can benefit from<br />
the expert help and advice<br />
TSA provides.<br />
The accounts of TSA align to the National Standard<br />
Chart of Accounts published by the Australian Charities and<br />
Not-for-profits Commission.<br />
As a grandfather of a young boy with TSC, I want to see this<br />
organisation succeed and be sustainable for the future so every<br />
family and person living with this disease can benefit from the<br />
expert help and advice TSA provides. Building upon our strong<br />
foundations will help us ensure we will be around for the longterm.<br />
TSA is committed to continue to work with the TSC<br />
community to secure the funding we need to achieve our goals and<br />
a sustainable future.<br />
Our work with pharmaceutical companies<br />
TSA has previously collaborated with Novartis and other<br />
pharmaceutical companies in a number of ways. This<br />
year we did not receive any project funding or support<br />
from the medicines industry. Our policy on working<br />
with pharmaceutical companies, which is available on our<br />
website (www.tsa.org.au), describes how we maintain our<br />
independence and integrity.<br />
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TSA News<br />
Financial Statements<br />
Balance Sheet as at 30 June <strong>2019</strong><br />
ASSETS 30 June <strong>2019</strong> 30 June 2018<br />
Bank<br />
General Cheque Account $88,728.34 $32,849.72<br />
PayPal $2,768.68 $0.00<br />
Savings Accounts $30,820.45 $10,117.88<br />
Term Deposits $188,359.02 $203,207.42<br />
Total Bank $310,676.49 $246,175.02<br />
Current Assets<br />
Accounts Receivables $317.50 $0.00<br />
Sundry Debtors $2,029.35 $2,916.01<br />
Total Current Assets $2,346.85 $2,916.01<br />
Total Assets $313,023.34 $249,091.03<br />
LIABILITIES<br />
Current Liabilities<br />
Accrued Expenses $8,000.00 $0.00<br />
GST $210.64 -$769.71<br />
PAYG Withholding Payable $1,648.00 $2,037.00<br />
Provision for Annual Leave $6,619.67 $6,511.82<br />
Provision for Long Service Leave $3,617.07 $0.00<br />
Salary Sacrifice Payable $0.00 $0.09<br />
Superannuation Payable $3,130.53 $2,367.04<br />
Suspense $0.00 -$350.00<br />
Trade Creditors $0.00 $56.27<br />
Unexpended Grants $64,049.47 $0.00<br />
Unpaid Expense Claims $693.93 $2,016.37<br />
Total Current Liabilities $87,960.31 $11,868.88<br />
Total Liabilities $87,960.31 $11,868.88<br />
Net Assets $225,063.03 $237,222.15<br />
EQUITY<br />
Current Year Earnings -$12,159.12 -$55,653.92<br />
Retained Surplus $237,222.15 $292,876.07<br />
Total Equity $225,063.03 $237,222.15<br />
11
TSA News<br />
Financial Statements<br />
Income and Expenditure: Year Ended 30 June <strong>2019</strong><br />
30 June <strong>2019</strong> 30 June 2018<br />
INCOME<br />
Donations Received $114,012.83 $64,397.35<br />
Grants Received $21,501.47 $13,785.24<br />
Event Income $35,114.70 $24,060.00<br />
Membership Contributions and Fees $12,272.75 $11,911.12<br />
Other Income $4,967.51 $5,283.39<br />
Sales of Goods $3,403.53 $3,760.01<br />
Total Trading Income $191,272.79 $123,197.11<br />
Gross Profit $191,272.79 $123,197.11<br />
OPERATING EXPENSES<br />
Accounting and Bank Fees $7,806.89 $8,245.32<br />
Advertising and Promotion $213.47 $97.27<br />
Consultancy Fees $2,100.00 $8,200.00<br />
Educational Event Expenses $5,208.80 $4,669.13<br />
Foreign Currency Gains and Losses $0.00 $325.62<br />
Fundraising and Event Expenses $16,143.76 $15,163.20<br />
Information Technology Expenses $8,352.70 $9,970.71<br />
Insurance Expense $2,839.19 $1,864.08<br />
Postage, Freight and Courier $3,197.25 $2,636.78<br />
Printing & Stationery $2,784.60 $5,932.75<br />
Publications and Information Resources $13,920.45 $3,883.57<br />
Research Grants Awarded $0.00 $2,495.45<br />
Salaries and Wages $125,240.33 $101,914.08<br />
Sundry Expenses $1,611.89 $2,997.36<br />
Telephone, Fax and Internet $1,029.87 $1,734.00<br />
Training & Development (Staff) $681.55 $314.81<br />
Travel & Accommodation $12,301.16 $8,406.90<br />
Total Operating Expenses $203,431.91 $178,851.03<br />
Deficit/Surplus -$12,159.12 -$55,653.92<br />
If you would like to<br />
see TSA’s Annual Report<br />
it is available<br />
online at www.tsa.org.au/<br />
annual-reports or, if you<br />
would like to receive a<br />
paper copy, simply send an<br />
email request to<br />
info@tsa.org.au<br />
12 <strong>Reach</strong><br />
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TSA News<br />
The Impact of Your Support This Year<br />
94<br />
TSC families helped through<br />
our TSC Information Service<br />
32,618<br />
People visited our website<br />
for information about TSC<br />
67<br />
TSC Information pages<br />
viewed each day<br />
1<br />
New TSC medicine<br />
included on the PBS<br />
520<br />
Members supported through our<br />
online discussion group<br />
25<br />
Families took part in a research project sharing<br />
their new diagnosis experience<br />
1,384<br />
Comments posted in<br />
our online discussion<br />
group<br />
65<br />
Australian TSC families<br />
have received their<br />
free children’s book about TSC<br />
15<br />
Adults participated<br />
in TSC Connect<br />
84<br />
Families attended TAND education events<br />
across the country<br />
1<br />
Elizabeth Pinkerton Memorial<br />
2<br />
Award presented<br />
Issues of <strong>Reach</strong><br />
<strong>Out</strong> published<br />
13
Events<br />
Communities Connecting<br />
for TSC Global<br />
Awareness Day <strong>2019</strong><br />
Celebrations<br />
On 15 May, Global Awareness Day inspired our TSC community<br />
to raise awareness and over $12,000 for people living with TSC.<br />
There were celebrations all around the country to mark this<br />
special day for our rare disease.<br />
Thank you for encouraging your communities to come<br />
together in support of your loved ones who live with TSC. There<br />
were pyjama days in Tasmania, morning teas in Victoria, dinners<br />
in Perth, online Facebook campaigns as well as many people<br />
taking selfies wearing their wave tattoos. What a wonderful<br />
achievement!<br />
Rob, Mimi and Roxie<br />
Blackmans Bay<br />
School PJ Day<br />
In celebration of Roxie<br />
Rob and Mimi’s daughter Roxie has TSC. For Global Awareness<br />
Day, Rob purchased some #Tatts4TSC tattoos via our website<br />
and posted a photo of his family wearing their wave tattoos on<br />
Facebook. By adding a donate button to their post, and sharing a<br />
little bit about their TSC journey, they inspired just over $4,000 in<br />
donations in support of our work.<br />
Heroes4Caleb in the Radio Hobart studio<br />
#Heroes4Caleb<br />
Caleb from Tasmania lives with TSC. His<br />
big sister Jemima decided to inspire her<br />
school, Blackmans Bay Primary School,<br />
to hold a pyjama day for TSC Global<br />
Awareness Day. They collected a gold<br />
coin from each student who wore their<br />
pyjamas to school. In return, students<br />
received a wave tattoo. They raised over<br />
$400.<br />
The ABC local radio station heard<br />
about Jemima’s plans and invited the<br />
whole family into the studio for an<br />
interview to help raise awareness for TSC<br />
and promote Jemima’s terrific efforts.<br />
You can listen to the interview on TSA’s<br />
YouTube channel.<br />
Caleb’s grandma Ros also got<br />
involved. She held a morning tea with 30 of her friends from the<br />
Davenport Uniting Church Fellowship Group and raised $550.<br />
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Events<br />
Rachel’s birthday<br />
Rachel from NSW’s Riverina region was celebrating her birthday<br />
around 15 May. Because her daughter lives with TSC, Rachel<br />
decided to combine her birthday with some fundraising for TSA.<br />
Rachel raised $800 and her birthday was all the more colourful<br />
with everyone wearing their temporary tattoos.<br />
Baker McKenzie<br />
Our new partner, Baker McKenzie, invited us into their firm for a<br />
morning tea to launch our partnership and celebrate TSC Global<br />
Awareness Day. The Baker McKenzie team presented us with a<br />
cheque for $1,600 and raised another $127 on the day. What a<br />
fantastic connection!<br />
Gayle and the<br />
Lions Club of<br />
Nyah<br />
Gayle’s family has been dealing<br />
Gayle’s wave cake<br />
with the challenges of TSC for a<br />
long time, as her adult daughter<br />
Amy lives with TSC. Gayle contacted her local Lions Club of Nyah in<br />
Victoria. By sharing a little about their life with TSC, Gayle secured a<br />
$1,500 donation.<br />
But Gayle didn’t stop there. She also held a morning tea with<br />
friends and with the nurses at her work. To top it off she baked a<br />
special wave cake to share the message that living with TSC is like<br />
riding waves. There are highs and lows and unpredictable tides that<br />
threaten to tow you under. Even though we often can’t control the<br />
TSC waves, we can learn to surf.<br />
At Baker McKenzie’s on TSC Global Awareness Day<br />
Sydney Children’s Hospital, Randwick<br />
The TSA team kicked off its TSC Global Awareness Day events at<br />
the TSC Clinic at Sydney Children’s Hospital in Randwick, NSW.<br />
We had a great time meeting the families who were there and<br />
sharing our #Tatts4TSC with all the children, families and doctors.<br />
In celebration of Sophie<br />
Gayle and friends<br />
A family in the Tasmanian suburb of Trevallyn got involved in<br />
TSC Global Awareness Day. Georgie held a morning tea at work to<br />
raise awareness of her eldest daughter Sophie who lives with TSC.<br />
CBA Commodities Team<br />
Todd, who works in institutional banking at CBA, was introduced<br />
to TSA through The Growth Project, which brings together charity<br />
and business leaders. Todd was paired with Clare Stuart, who was<br />
then General Manager of TSA. Todd inspired his work team to<br />
donate. They raised over $1,300.<br />
Galada Kindy<br />
Tracey organised an awareness morning tea at Galada Kindy in<br />
Epping in Victoria. She baked lots of goodies and shared them with<br />
her early childhood educator colleagues.<br />
Thank you also to everyone who purchased<br />
tattoos and wore them on 15 May. We sold<br />
140 which helped us raise over $400.<br />
Thank you to everyone who made this year’s<br />
Global Awareness Day such a huge success.<br />
15
Events<br />
Connecting with Other<br />
Organisations<br />
As a small not-for-profit organisation, the team at TSA knows<br />
how important it is to collaborate and connect with other<br />
rare disease and patient organisations. This ensures we make the<br />
best use of resources, stay aware of things happening in, and to,<br />
the sector, and join forces to advocate on particular issues.<br />
TSA does this on both an international and a local level.<br />
We have particularly strong ties with Tuberous Sclerosis<br />
Complex New Zealand, our sister patient organisation across<br />
the Tasman.<br />
TSA is fortunate to be included in several forums where<br />
members freely and gladly share their expertise and knowledge.<br />
In this issue of <strong>Reach</strong> <strong>Out</strong> we give you a glimpse of a couple<br />
of the events that helped us connect with other like-minded<br />
organisations.<br />
TSA connected with 100 other local charities<br />
In May this year, Clare Stuart and Jackie Gambrell (the former<br />
and current TSA General Managers respectively), attended the<br />
inaugural Australian Patient Organisation Network Conference<br />
(APON) in Sydney. Over 100 charities participated in this<br />
event. This is a starting point in bringing patient organisations<br />
together and developing networks. The idea is that a cohesive<br />
and collaborative non-profit sector can be leveraged to<br />
address common goals. Participating organisations, including<br />
TSA, identified the following challenges in supporting their<br />
communities:<br />
• Creating sustainable organisations<br />
• Equity of access for all<br />
• Health literacy<br />
• Health system navigation<br />
• Stigma and visibility.<br />
APON charities agreed to work together to come up with<br />
potential solutions to these challenges and to advocate for<br />
change. We’ll keep you posted on our progress.<br />
TSA connected with international TSC patient<br />
associations<br />
In June this year, Jackie Gambrell, TSA’s General Manager, and<br />
Dr David Mowat, one of TSA’s Medial Advisors, made their<br />
way to Toronto for the TSC International (TSCi) Research<br />
Conference. 250 people from 28 countries attended. It was<br />
fantastic to see the depth and breadth of research being<br />
conducted across the globe by many brilliant minds. It shows<br />
just how much research into TSC is taking place!<br />
At a workshop representing 25 patient organisations from<br />
around the world, we shared ideas about some of the challenges we<br />
each face, including:<br />
• finding and connecting with all those who have TSC<br />
• engaging with clinicians and researchers and raising their<br />
interest in TSC<br />
• getting the clinical guidelines known and implemented<br />
• working towards early diagnosis and treatment<br />
• achieving optimal assessment of TAND (TSC-associated<br />
neuropsychiatric disorders).<br />
For more details on the research conference visit: http://online.<br />
fliphtml5.com/tosk/ghir/ or listen to the podcast at: https://tscnow.blubrry.net/<strong>2019</strong>/07/16/episode-3-the-<strong>2019</strong>-international-tscresearch-conference/#more-39<br />
TSA extends a sincere thanks to TSC International for providing<br />
funding so TSA could attend this important TSC event.<br />
Many advances have been made in tuberous sclerosis complex (TSC) in<br />
the last thirty years. In addition to identifying the molecular basis for TSC, it<br />
has become clear that affected individuals benefit greatly from early diagnosis,<br />
understanding of the true nature of the disorder, and thoughtful, progressive<br />
medical, surgical and psycho-social management. There is understandable<br />
excitement about increased understanding of the causes of TSC, as well as the<br />
new and targeted treatments available for it.<br />
David Neal Franz, Keynote Speaker at the TSCi Research Conference <strong>2019</strong><br />
Founding Director, TS Clinic, Children’s Hospital Medical Centre, Cincinnati<br />
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Research<br />
EPISTOP:<br />
International<br />
Research Results on<br />
Epilepsy<br />
Dr Kate Riney<br />
One of the most exciting presentations at this year’s TSC<br />
International Research Conference was delivered by<br />
Professor Sergiusz Jozwiak, Paediatric Neurologist and Head of<br />
Department of Neurology at the Children’s Memorial Health<br />
Institute in Warsaw, Poland.<br />
Professor Jozwiak is Project Coordinator of the EPISTOP<br />
Project, one of the largest international scientific research<br />
programs on epilepsy. He delivered a session called, “Lessons<br />
learnt from the EPISTOP study.”<br />
EPISTOP was a multi-centre project aimed at improving<br />
epilepsy management in individuals with TSC. It involved 101<br />
infants under the age of four months diagnosed with TSC. The<br />
study had two goals:<br />
• to compare the results of standard and preventative<br />
treatment of epilepsy in infants with TSC<br />
• to identify biomarkers that can predict the development of<br />
epilepsy in a child with TSC.<br />
In the randomised trial, standard treatment with vigabatrin<br />
started after the onset of clinical or sub-clinical seizures, was<br />
compared to preventive treatment started because of epileptiform<br />
abnormalities on EEGs but before the onset of seizures.<br />
According to Professor Jozwiak, the EPISTOP project proved<br />
that preventive treatment decreased the risk and severity of<br />
epilepsy. The study showed that preventive vigabatrin treatment<br />
delayed the onset of seizures, reduced risk of drug-resistant<br />
epilepsy, reduced the number of antiepileptic drugs required and<br />
reduced the number of days with seizures.<br />
Professor Jozwiak said the study also showed that a first<br />
abnormal EEG or seizure onset at younger age is associated<br />
with higher prevalence of developmental delay or autism and<br />
that the prevalence of these was higher in patients with drugresistant<br />
epilepsy.<br />
Professor Jozwiak noted that no patients in EPISTOP<br />
presented severe neuropsychological deficits at two years of age,<br />
probably due to the close monitoring.<br />
The EPISTOP results offer new insights into epilepsy<br />
management. Whilst there is still more work to do, the results<br />
have the potential to be used to develop recommendations for the<br />
detection and treatment of epilepsy around the world, including<br />
early interventions to improve outcomes.<br />
The project also identified potential biomarkers for epilepsy<br />
development.<br />
EPISTOP results have the<br />
potential to be used to develop<br />
recommendations for the detection<br />
and treatment of epilepsy in people<br />
with TSC around the world, including<br />
early interventions to improve<br />
outcomes.<br />
Professor Sergiusz Jozwiak<br />
Based on the study results EPISTOP has formulated the<br />
following clinical recommendations:<br />
• Early diagnosis is a must. It enables close monitoring and<br />
early intervention for epilepsy, developmental delay and<br />
autism.<br />
• Serial video EEGs should be carried out every 4-8 weeks<br />
in the first two years of life and neurodevelopmental<br />
evaluations should be carried out every six months.<br />
TSA would like to acknowledge Professor Jozwiak and his fellow<br />
collaborators, including Australian TSC clinical researcher Dr Kate<br />
Riney and her colleagues at Children’s Health Queensland, for their<br />
participation in EPISTOP. And, of course, we extend a huge thank<br />
you to all of the children and families who took part in this study.<br />
To find out more, please see https://tsa.org.au/epistop-researchprogram-results/<br />
or visit www.epitstop.eu<br />
17
Research<br />
Research<br />
News<br />
Clinical characteristics of SEGAs in TSC<br />
This study, conducted at 170 sites across 31 countries, looked at the<br />
clinical characteristics of subependymal giant cell astrocytoma<br />
(SEGAs) in children and adults with TSC. The data comes from<br />
the TOSCA registry (TuberOus SClerosis registry to increase<br />
disease Awareness), which was designed to provide deeper insights<br />
into the manifestations of TSC and its management. Data from<br />
patients of any age with a documented clinical visit for TSC in the<br />
12 months preceding enrolment or those newly diagnosed with<br />
TSC was included.<br />
SEGA were reported in 25% of the 2,216 patients on the registry,<br />
with the median age of diagnosis of SEGA being 8 years. SEGA were<br />
more often associated with TSC2 mutations compared to those with<br />
a TSC1 mutation. The study highlights that the rates of SEGA in<br />
patients with TSC may be higher than previously reported.<br />
SEGA caused symptoms in 42% of patients. The most common<br />
symptoms among patients were increased frequency in seizures<br />
(16%) and behavioural disturbance (12%). The main treatments<br />
patients received were surgery and mTOR inhibitors.<br />
Of interest, prior reports of SEGA growth after the age of 25 years<br />
have been rare but, in this study, growing SEGA were reported in 19<br />
patients who were over the age of 18. This confirms that, although<br />
SEGA diagnosis and growth typically occurs during childhood, SEGA<br />
can occur and grow in both infants and adults.<br />
This study once more highlights the need<br />
for all those with TSC to follow the<br />
international recommendations for<br />
The [study] confirms that<br />
although SEGA diagnosis<br />
and growth typically occurs<br />
during childhood, SEGA can<br />
occur and grow in both infants<br />
and adults.<br />
the surveillance and management<br />
of TSC which recommends brain<br />
imaging until the age of 25 years.<br />
Jansen et al, Clinical<br />
Characteristics of Subependymal<br />
Giant Cell Astrocytoma in<br />
Tuberous Sclerosis Complex,<br />
Frontiers in Neurology, <strong>2019</strong> Jul<br />
3;10:705. doi: 10.3389/fneur.<strong>2019</strong>.00705.<br />
eCollection <strong>2019</strong>.<br />
Sirolimus therapy for cardiac rhabdomyoma in pregnancy<br />
This is a case report of a pregnant 32 year old woman who had been<br />
diagnosed with TSC when she was aged 24 and was being treated<br />
with oral sirolimus to manage her lymphangioleimyomatosis (LAM,<br />
a lung condition associated with TSC).<br />
She stopped treatment when she became pregnant. At 21 weeks<br />
into her pregnancy, cardiac echo found a cardiac rhabdomyoma<br />
in her baby. Rhabdomyoma is the most common foetal cardiac<br />
tumour, and its development is related to tuberous sclerosis. The<br />
woman’s medical team recommenced sirolimus and continued to<br />
monitor the pregnancy. A repeat cardiac echo at 29 weeks found no<br />
visible cardiac rhabdomyoma. The woman continued on sirolimus<br />
until delivery of her baby at 39 weeks. Her baby was born with<br />
no cardiac rhabdomyomas, but was found to have subependymal<br />
nodules and possible kidney lesions.<br />
This is the first report of complete resolution of cardiac<br />
rhabdomyomas in a pregnant woman with TSC treated with<br />
sirolimus. But, the authors caution that further studies are needed<br />
to determine the safety of the drug in pregnant women. This case<br />
highlights the need for targeted imaging of pregnant woman with<br />
TSC and the potential for early intervention.<br />
Park et al, Sirolimus therapy for fetal cardiac rhabdomyoma in a<br />
pregnant woman with tuberous sclerosis, Obstetrics & Gynaecology<br />
Science, <strong>2019</strong> Jul;62(4):280-284. doi: 10.5468/ogs.<strong>2019</strong>.62.4.280. Epub<br />
<strong>2019</strong> Jun 21.<br />
This is the first report of complete<br />
resolution of cardiac rhabdomyomas<br />
in a pregnant woman with TSC treated<br />
with sirolimus…but…further studies<br />
are needed to determine the safety of<br />
the drug in pregnant women.<br />
18 <strong>Reach</strong><br />
OCTOBER <strong>2019</strong> ISSUE 110<br />
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Research<br />
Gaps in surveillance<br />
In 2016 the Comprehensive TSC Clinic was established at The Hospital<br />
for Sick Children in Toronto, Canada. This new clinic wanted to<br />
understand the gaps in service that those being referred to it may<br />
have experienced. The clinic conducted a retrospective review of the<br />
medical records of all its patients with TSC seen between January 2016<br />
and December 2017. The aim was to see if appropriate surveillance,<br />
as advised by the 2012 Tuberous Sclerosis Complex Consensus<br />
Recommendations, was completed prior to these patients attending the<br />
clinic.<br />
The clinic saw 90 patients during this period who were aged less<br />
than 18 years. The review of these children’s medical records found that<br />
the majority had received the following TSC surveillance:<br />
• central nervous system surveillance (EEG<br />
and/or MRI)<br />
• renal and cardiac surveillance<br />
• genetic evaluation and counselling<br />
• dermatological (skin), dental<br />
and ophthalmologic (eyes)<br />
surveillance.<br />
However, the review<br />
found the one area that<br />
was poorly addressed was<br />
This review suggests that<br />
neuropsychiatric surveillance<br />
patients and health<br />
using the TAND checklist.<br />
professionals should put<br />
TAND stands for TSC<br />
more emphasis on assessing<br />
Associated Neuropsychiatric<br />
and treating TAND.<br />
Disorders and refers to the wide<br />
range of cognitive, behavioural<br />
and mental health challenges that<br />
people with TSC are at risk of.<br />
It is estimated that about 90% of<br />
individuals with TSC will experience some<br />
degree of TAND symptoms which may include features which may<br />
include depression, anxiety, autism spectrum disorder, sleep difficulties<br />
and cognitive difficulties. Yet, in this review of medical records, the<br />
TAND checklist was completed prior to attending the clinic in only four<br />
out of the 90 cases.<br />
Early recognition of TAND symptoms allows for early intervention,<br />
and treatments or programs that can help to meet the needs of<br />
children and adults with TSC and their families. This review suggests<br />
that patients and health professionals should put more emphasis on<br />
assessing and treating TAND.<br />
For more information on TAND and the TAND checklist visit<br />
https://tsa.org.au/information/tand/<br />
Surveillance and<br />
management guidelines for<br />
tuberous sclerosis<br />
Tuberous sclerosis complex (TSC) is a genetic disorder that may affect nearly every<br />
organ system. TSC affects people in many different ways and with differing degrees<br />
of severity. Signs and symptoms of TSC can also progress at different rates in different<br />
individuals. This diversity and variation make it challenging to determine what<br />
healthcare is needed achieve the best quality of life for a person with TSC.<br />
Healthcare professionals from around the world with expertise managing TSC have<br />
developed guidelines for the surveillance and management of TSC. These have been<br />
published in a series of peer-reviewed papers. This publication summarises these<br />
consensus guidelines to help people with TSC, their families and health professionals.<br />
WHAT IS TSC?<br />
Tuberous sclerosis complex (TSC) is a<br />
genetic disorder that affects many organs<br />
and causes non-malignant tumors in the<br />
skin, kidney, brain, heart, eyes, lungs, teeth<br />
or oral cavity, and other organs. Individuals<br />
with TSC may be initially diagnosed because<br />
of involvement in any or all of these organs,<br />
often depending on the age at which a<br />
person receives the diagnosis.<br />
Individuals of all ages may receive the<br />
diagnosis of TSC depending on the signs and<br />
symptoms they have. The diagnosis of TSC<br />
may occur after the development of facial<br />
angiofibromas in an adolescent, because<br />
of the presence of heart tumours (cardiac<br />
rhabdomyomas) in a newborn or the onset<br />
of kidney problems in an adult. However, in<br />
the majority of cases, the diagnosis of TSC<br />
comes after the start of seizures.<br />
The severity of TSC can range from mild to<br />
severe, even within the same family if more<br />
than one person has TSC. The diagnosis of<br />
TSC and further evaluation of people at risk<br />
for TSC involve careful examination of the<br />
skin, heart, eyes, brain, lungs and kidneys,<br />
as well as genetic testing. It is important to<br />
know the disorder’s signs and symptoms<br />
and to follow the recommendations for<br />
screening and evaluating TSC.<br />
It is estimated that TSC affects 1 in 6,000 live<br />
births. Nearly 1 million people worldwide are<br />
estimated to have TSC, with approximately<br />
2,000 in Australia. TSC shows no gender bias<br />
and occurs in all races and ethnic groups.<br />
You can read more about the signs and<br />
symptoms of TSC at<br />
www.tsa.org.au/information<br />
Alsowat et al, A Review of Investigations for Patient With Tuberous<br />
Sclerosis Complex Who Were Referred to the Tuberous Sclerosis Clinic<br />
at The Hospital for Sick Children: Identifying Gaps in Surveillance,<br />
Paediatric Neurology, <strong>2019</strong> Jul 4. pii: S0887-8994(19)30511-9. doi:<br />
10.1016/j.pediatrneurol.<strong>2019</strong>.06.018. [Epub ahead of print]<br />
19
Research<br />
Australian Families’<br />
Experience with a TSC<br />
Diagnosis<br />
One of the not-for-profit organisations TSA collaborates with<br />
is the Centre for Community-Driven Research (CCDR),<br />
a non-profit organisation bringing change to community<br />
engagement in health and research. Patient Experience,<br />
Expectations & Knowledge (PEEK) is a research program<br />
developed by CCDR. PEEK studies provide a clear picture and<br />
historical record of what it is like to be a patient at a given point<br />
in time. PEEK studies help inform how best to support patients<br />
with treatments, information and care.<br />
Earlier this year, in preparation for developing our new<br />
diagnosis resources, CCDR completed a mini-PEEK study<br />
investigating the experiences of 25 families from around<br />
Australia when their child was diagnosed with tuberous sclerosis<br />
complex (TSC).<br />
The study found that it was most often white spots on the skin,<br />
seizures and delayed development that provided the first clues that<br />
led to a diagnosis of TSC. The most common health professional<br />
to diagnose TSC was a neurologist or paediatrician, although GPs<br />
were also commonly involved in the diagnosis process.<br />
Half of the families in the study said that enough information<br />
was given at diagnosis, and half that not enough information<br />
was given, with one family saying they had no information at all.<br />
Parents of newly diagnosed children wanted to find out about<br />
disease management, treatment options, hereditary considerations<br />
and genetics, disease cause and allied health information.<br />
It was acknowledged that a TSC diagnosis is often a shock and<br />
about 20% of those interviewed said they needed to get through<br />
that shock before they were receptive to information.<br />
More than half of those interviewed (60%) reported they<br />
did not have adequate emotional support between testing and<br />
diagnosis, with 35% of parents reporting they had no emotional<br />
support at all.<br />
There was recognition from parents that more tailored<br />
information would be helpful at new diagnosis. There were<br />
comments such as: “When my child was first diagnosed there<br />
wasn’t really like a resource list for where to go, who to contact.<br />
You know, you can get help in this area or that area. That would be<br />
the biggest thing I think. If someone was recently diagnosed that’s<br />
what I think would be most helpful initially.”<br />
The study reports that most parents made treatment decisions<br />
in collaboration with their health professionals, highlighting<br />
the importance of that team in pursuing the right treatment<br />
options. The importance of TSC specialists was highlighted, with<br />
parents describing difficulties of having to educate their GPs,<br />
paediatricians and other non-TSC specialists.<br />
Half of those interviewed reported at least some difficulties<br />
paying for basic necessities such as housing, food and electricity<br />
as a result of TSC in their family. Many said that TSC had a large<br />
impact on their ability to<br />
work with half having<br />
More than half of those<br />
to reduce the number<br />
interviewed (60%) reported<br />
of hours they worked.<br />
they did not have adequate<br />
A quarter of these<br />
emotional support between testing<br />
families felt their<br />
and diagnosis, with 35% of parents<br />
reduced earning ability<br />
reporting they had no emotional<br />
had been an extremely<br />
support at all.<br />
significant burden of<br />
the disease. Parents were<br />
generally not informed of their<br />
financial entitlements.<br />
From the CCDR interviews, it was<br />
clear that parents of children with TSC are very knowledgeable<br />
about the condition and related symptoms and treatments. They<br />
take a very active role in managing TSC and there is a lot to learn<br />
to be able to do that job.<br />
Parents said they were most interested in learning about what<br />
causes TSC, how TSC is best managed and what the available<br />
treatment options are. Health professionals provide some<br />
information. Parents are also searching online for information to<br />
improve their knowledge. Those interviewed said they preferred<br />
to talk to someone and also go online for information, with most<br />
identifying the combination of these as important. Interviewees<br />
cited TSA as the most trusted information source, even more so<br />
that health professionals (although the sample may be biased<br />
because recruitment was done through TSA). Those interviewed<br />
stressed that information has to be current and described old<br />
information as not helpful and sometimes even harmful.<br />
Many of those interviewed said they had a fear of progression<br />
of TSC and concerns about their child reaching educational and/or<br />
personal goals because of the disease.<br />
There were many suggestions for advice to future TSC<br />
families, including:<br />
• allowing time to adjust<br />
• learning as much as possible about TSC and becoming an<br />
advocate<br />
• seeking a second opinion<br />
• connecting with support groups and seeking support<br />
from family and friends<br />
• sharing experiences<br />
• being open to changes to lifefocusing on the positive.<br />
TSA would like to thank all the families who participated in<br />
this research and thank CCDR for undertaking the study. This<br />
research is an important platform in the development of TSA’s New<br />
Diagnosis “Parachute” Pack which is due to be launched in late <strong>2019</strong>.<br />
TSA would also like to acknowledge our partner nib foundation for<br />
supporting this project.<br />
20 <strong>Reach</strong><br />
OCTOBER <strong>2019</strong> ISSUE 110<br />
<strong>Out</strong>
TSA Research Awards<br />
Congratulations to<br />
Dr Fiona McKenzie<br />
Winner of the Elizabeth Pinkerton Memorial Award <strong>2019</strong><br />
Tuberous Sclerosis Australia (TSA) is delighted to announce<br />
that Dr Fiona McKenzie, Geneticist at the King Edward<br />
Memorial Hospital for Women in Subiaco, Western Australia, is<br />
the recipient of the <strong>2019</strong> Elizabeth Pinkerton Memorial Award.<br />
This award is given annually with TSA to a health professional<br />
in recognition of their efforts to improve the lives of people<br />
affected with tuberous sclerosis complex (TSC) in Australia and<br />
their families. Nominations for the award are open, via TSA’s<br />
website, from May to July each year.<br />
Members of the Australian TSC Community nominated<br />
Dr McKenzie for this year’s award. She was recognised in<br />
particular for her long-term perseverance in assisting one TSC<br />
adult to search for the cause of their mosaic TSC, and for her<br />
considered counselling to TSC families planning to conceive<br />
a child. As one family commented: “Dr McKenzie counselled<br />
us when we were planning to conceive and have our first child.<br />
We wouldn’t have had the confidence to go forward without her<br />
advice.”<br />
Dr McKenzie joins the illustrious ranks of past winners of this<br />
award which include Dr David Mowat, Dr John Lawson, Dr Kate<br />
Riney, Dr Sean Kennedy, Dr Anne Halbert, Dr Simon Harvey,<br />
Dr Helen Whitford and Dr Orli Wargon.<br />
Lizzie Pinkerton<br />
Elizabeth (Lizzie)<br />
Pinkerton (1984 –<br />
2010) had tuberous<br />
sclerosis complex and<br />
polycystic kidney disease.<br />
Lizzie lived a life full of friends,<br />
dancing and laughter. She<br />
provided inspiration for her<br />
family’s involvement in TSA,<br />
which has continued for<br />
over 25 years.<br />
21
Fundraising<br />
Snapshot<br />
We need you! We depend on donations and fundraising from our TSC<br />
community. We’d love you to get involved and support TSA if you don’t<br />
already. You can make a big difference to our work – we need funding to<br />
continue to help and support you, our TSC families. Please call us to discuss<br />
how you can get involved on 0434 391 430 or email kate.garrard@tsa.org.au<br />
Thank you to all our generous supporters around Australia who help<br />
make our work possible.<br />
Comedy for a Cure is coming to Sydney<br />
Tickets are now on sale for Sydney’s first Comedy for a Cure to be held on Saturday<br />
26 <strong>October</strong> at Paddo RSL. We hope you will join us for a night where we will harness<br />
the power of laughter to raise critically needed funds to help people affected by TSC.<br />
Comedy for a Cure will feature a fantastic line up of comedians with Peter Berner<br />
headlining the show. We hope you will come along and bring your family and friends<br />
too! More details on the back page of <strong>Reach</strong> <strong>Out</strong>.<br />
Lizzie’s Lunch<br />
The 6th annual Lizzie’s Lunch was held on Sunday 2 June at The Hills Lodge in Castle Hill.<br />
It was a fantastic event made possible thanks to the extraordinary efforts and dedication<br />
of Lizzie’s mum, Sue Pinkerton. There were many people who came together to make it a<br />
special day. Thanks to our fantastic Master of Cereominies Ron Wilson, parent speakers<br />
Natalie and Mark with their gorgeous boy Sammy, and our hard-working volunteers Paul,<br />
Tom, Ellie, Sam, Nina and Deb. And, of course, thank you to all the generous guests in the<br />
room who raised an amazing $22,000. These funds will have a big impact on TSA’s work<br />
with and for the TSC Community.<br />
Lizzie’s Lunch<br />
#Heroes4Kristian<br />
Kristian’s team of heroes have donated<br />
almost $8,000 in honour of Kristian who<br />
lives with TSC. On Sunday 31 March the<br />
Kalymnian Club hosted a car and bike show<br />
fundraiser for TSA. They had a great turn<br />
out, despite the chilly Melbourne weather,<br />
and raised $4,600. Thank you to everyone<br />
who supported<br />
this fantastic<br />
event and to Jo<br />
and Kon Romios,<br />
Kristian’s<br />
parents, for<br />
inspiring<br />
this generous<br />
contribution.<br />
Kristian<br />
Memberships<br />
TSA relies on memberships to fund its programs and services and ensure<br />
everyone can access our services for free. We are grateful to all our members<br />
for your generous contributions. Many memberships have recently expired.<br />
We hope we can count on your support again this year. We have also set up a<br />
recurring membership option. If you choose this, your membership will renew<br />
automatically each July so you won’t have to worry about it expiring ever again!<br />
Good news on grants<br />
TSA has been working hard to secure grant funding for several new projects.<br />
We’ve had some small and some big wins which we are very excited about.<br />
We’d like to thank nib foundation, Ian Potter Foundation, Lotterywest, the<br />
Centre for Community-Driven Research, Universal Charitable Fund and the<br />
Department of Social Services for looking favourably upon our applications<br />
and partnering with us to help people living with TSC. These grants will help<br />
TSA launch new diagnosis resources, run educational events for families and<br />
a TSA’s new nurse service.<br />
22<br />
<strong>Reach</strong><br />
<strong>Out</strong><br />
OCTOBER <strong>2019</strong> ISSUE 110
Fundraising<br />
Meet our TSC Heroes<br />
NIB team<br />
Our partner nib foundation<br />
got a team of 30 staff<br />
together to participate in<br />
Sydney’s City2Surf. They<br />
raised $3,121 and then nib<br />
matched every dollar. What<br />
a fantastic effort!<br />
TSC Hero Tess<br />
Tess ran the London<br />
Marathon and raised $2,000.<br />
She is also going to participate<br />
in the New York Marathon<br />
later this year. Go Tess!<br />
TSC Heroes Melissa and team<br />
Our TSC Hero Melissa put<br />
together a team of colleagues<br />
from HMAS Warramunga for<br />
Perth’s Run for a Reason. Here<br />
is a photo of them training for<br />
the big day. They raised $648.<br />
Great job!<br />
TSC Hero Natasha<br />
Natasha ran in Sydney’s Half<br />
Marathon on 15 September in<br />
honour of her granddaughter<br />
who was diagnosed with<br />
TSC late last year. So far she<br />
has raised $4,000. Well done<br />
Natasha!<br />
Will you be a #Hero4TSC?<br />
Many of our TSC community already support our work in a variety of ways for which we are enormously<br />
grateful. Now we are making it even easier to encourage your family and friends to donate in honour of<br />
your family or the person you know with TSC under an individual #Heroes4TSC campaign.<br />
See the photo we’ve created for Caleb’s hero page.<br />
Set up a hero campaign. It’s simple! Just call Kate or visit https://tsa.org.au/heroes4TSC/<br />
Sammy<br />
Tax-time appeal,<br />
another success<br />
A massive thank you to everyone in our<br />
TSC community who so generously<br />
supported our tax-time appeal this<br />
year. Gorgeous little Sammy helped us<br />
spread our message. Over $7,000 was<br />
donated to help fund our services and<br />
program.<br />
Budget Petrol Station<br />
Thanks to the efforts of Lilly’s parents, Michael and<br />
Chauntelle, customers visiting Earlwood’s Budget<br />
Petrol Station have been encouraged to donate their<br />
change to TSA with a donation tin at the register.<br />
They raised $777. Great job!<br />
Join our team of TSC Heroes<br />
Do you run, walk, swim, cycle? Why not join our TSC Hero<br />
team and participate in a fun run, marathon or triathlon as a<br />
tribute to the person you know with TSC.<br />
Our TSC Hero teams are located all around the country.<br />
You can have a go and become a hero too. It’s easy – just follow<br />
our TSC Heroes Facebook page, find an event in your city,<br />
then engage with your family and friends to make donations.<br />
Check out our website for more information.<br />
Upcoming Fundraising Events<br />
Sunday 13 <strong>October</strong> <strong>2019</strong> - Melbourne Marathon<br />
Sunday 20 <strong>October</strong> <strong>2019</strong> - TSC Hero Burnie 10<br />
Saturday 26 <strong>October</strong> <strong>2019</strong> - Comedy for a Cure, Sydney<br />
Sunday 3 November <strong>2019</strong> - TSC Hero NY Marathon<br />
Sunday 14 June 2020 - Save the Date - Lizzie’s Lunch<br />
Thank you again to all our supporters for your extraordinary help. YOU make a<br />
difference to people living with TSC. We couldn’t do it without you.<br />
23
LAST CHANCE TO GET<br />
YOUR TICKETS!<br />
BUY YOURS TODAY!<br />
Comedy for a Cure is coming to Sydney this<br />
year on Saturday 26 <strong>October</strong>. This great<br />
night will harness the power of laughter to<br />
raise critically needed funds to help people<br />
affected by TSC.<br />
Please come along and invite your friends,<br />
family and colleagues to join us too. It’s a<br />
fun way for your network to show their<br />
support. There is special reserved seating<br />
for groups of 10 or more.<br />
All funds raised from this night will be<br />
used to ensure children and adults living<br />
with TSC across Australia have access to<br />
ground-breaking new treatments and<br />
research that are taking us closer to a<br />
cure for this devastating disease.<br />
Get your tickets now!<br />
www.comedyforacure.org.au