My client is a young woman who severely disabled because of tuber sclerosis. She has severe learning difficulties, is extremely disruptive and very volatile and no way can she be out on her own We've just got HRC for her but they've left LRM as it is.

The only thing I know about this condition is that benign tumours replace brain tissue.

I would have thought HRM would have been more appropriate and I've just written for full reasons..

I'm of the opinion it really should merit an award of HRM but because they'd also review the HRC (which has taken her mum years of trying) I'd like a second opinion.

Dos anyone have any experience or knowledge of this condition and whether HRM would be appropriate ?

My big book of medical facts says that tuberous sclerosis is a very rare genetic disease that often doesn't manifest until quite late in childhood and can include multiple skin problems and epilepsy as well as severe mental retardation. Interestingly it's described as an autosomal dominant which means that you will get it if you inherit it from only one of your parents - is either of her parents affected? If not it may be a new mutation.
You would need to know whether her condition began to trouble her at a date which is consistent with "arrested or incomplete development of the brain" - probably, if it began in childhood, and you might need medical evidence to that effect. It sounds as if she has severely impaired intelligence, anyway (it goes with the diagnosis).

So what would happen if she goes out? How extreme is her behaviour? Can she ever be left unsupervised? Have police/social services ever been involved because of her getting out of control? Can she be calmed down with words alone or does she need physical restraint? As usual it's a question of fact and degree and no-one can tell you a "right" answer. Do you actually feel the PDCS would take away her HRC and if so why might they?

Many thanks for such a comprehensive response ariadne, it's very helpful. I've already asked her mum to come in so we can go through her whole history to get all the relevant facts. In the meantime I've asked for a written statement of reasons for the decision

Her behaviour is very extreme and from what I've witnessed I can't imagine her ever being able to go out on her own.