Table 3.

Stages of TSC clinic development

Stage of Clinic Development	Services Provided
Maturity Level 1	• Care coordinator o Schedule appointments and investigations o First point of contact for advice • Lead Clinician o With TSC interest and expertise o Created referral pathways • Close collaboration with patient/family organizations
Maturity Level 2	• Care provided jointly by a core group of TSC-knowledgeable physicians from relevant specialtiesa • MDTs to review cases and agree on management plans • Facilitate advice and care from a broader network of specialties and from a wider geographic area than the clinic can provide • Establish links with other TSC clinics (via MDTs or other joint meetings for peer-to-peer continuing education) • Formalize surveillance for TAND problems, e.g., using the TAND checklist • Use database to facilitate monitoring of patients
Maturity Level 3	• Work with larger network of local TSC-knowledgeable specialists; within the same care provider or closely allied care providers • Establish and promote local and regional network of specialists and care providers; acting as expert center providing advice and at least annual holistic review • Provide expertise for review of mental health and coordination of referrals for mental health problems
Maturity Level 4 (Center of Excellence)	• All the above, plus engage with research into TSC

MDT multi-disciplinary team, TAND TSC-associated neuropsychiatric disorder, TSC tuberous sclerosis complex

^aSpecialties useful in providing TSC services: pediatrics, genetics, diagnostic radiology, interventional radiology, cardiology, pediatric/adult neurology, respiratory medicine, pediatric/adult nephrology, dermatology, neurosurgery, oncology, fetal medicine, urology, ophthalmology, psychiatry, psychology, intellectual disability specialists, surgery