Introduction: Tuberous sclerosis complex (TSC) is an autosomal dominant, variably expressed multisystemic disease. TSC-associated neuropsychiatric disorders (TAND) present at multilevel, and probably are underestimated in terms of both assessment and treatment.
Case: We present a 16-year-old boy with epilepsy and psychosis, presenting with auditory hallucinations and grandiose delusions. He did not benefit from risperidone treatment. He had generalized seizures and his electroencephalogram showed generalized periodic epileptiform activity alternating with attenuation periods. Hypopigmented macules on examination combined with neuroimaging findings including cortical and subcortical tubers with radial bands lead to the diagnosis of TSC.
Discussion: There is an age-related variation in the expression of TAND in terms of behavioral, intellectual, psychosocial and psychiatric levels. Acute psychosis with epileptic encephalopathy may be a presenting feature in adolescence, and should be managed in parallel with antiepileptic treatment.