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Deguti MM, Araujo FC, Terrabuio DRB, Araujo TF, Barbosa ER, Porta G, Cançado ELR. Wilson disease: the diagnostic challenge and treatment outcomes in a series of 262 cases. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 38811021 DOI: 10.1055/s-0044-1786855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Wilson disease (WD) is an autosomal recessive disorder that leads to organ toxicity due to copper overload. Early diagnosis is complicated by the rarity and diversity of manifestations. OBJECTIVE To describe the diagnostic features and response to treatment in our cohort of WD patients. METHODS This was a retrospective analysis of 262 WD patients stratified by clinical presentation, complementary exams, ATP7B genotyping, and response to treatment. RESULTS Symptoms occurred at an average age of 17.4 (7-49) years, and patients were followed up for an average of 9.6 (0-45) years. Patients presented mainly with hepatic (36.3%), neurologic (34.7%), and neuropsychiatric (8.3%) forms. Other presentations were hematologic, renal, or musculoskeletal, and 16.8% of the patients were asymptomatic. Kayser-Fleischer rings occurred in 78.3% of the patients, hypoceruloplasminemia in 98.3%, and elevated cupruria/24h in 73.0%, with an increase after D-penicillamine in 54.0%. Mutations of the ATP7B gene were detected in 84.4% of alleles. Brain magnetic resonance imaging showed abnormalities in the basal ganglia in 77.7% of patients. D-penicillamine was the first choice in 93.6% of the 245 patients, and 21.1% of these patients were switched due to adverse effects. The second-line therapies were zinc and trientine. The therapeutic response did not differ significantly between the drugs (p = 0.2). Nine patients underwent liver transplantation and 82 died. CONCLUSION Wilson disease is diagnosed at a late stage, and therapeutic options are limited. In people under 40 years of age with compatible manifestations, WD could be considered earlier in the differential diagnosis. There is a need to include ATP7B genotyping and therapeutic alternatives in clinical practice.
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Affiliation(s)
- Marta Mitiko Deguti
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, São Paulo SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Gastroenterologia e Hepatologia, São Paulo SP, Brazil
| | - Fabiana Cordeiro Araujo
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, São Paulo SP, Brazil
| | | | - Thiago Ferreira Araujo
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Gastroenterologia e Hepatologia, São Paulo SP, Brazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Gilda Porta
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, São Paulo SP, Brazil
| | - Eduardo Luiz Rachid Cançado
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, São Paulo SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Gastroenterologia e Hepatologia, São Paulo SP, Brazil
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Tornabene D, Bini P, Gastaldi M, Vegezzi E, Asteggiano C, Marchioni E, Diamanti L. Neurological complications due to copper deficiency in the context of Wilson disease treatment: a case report with long-term follow-up and review of the literature. Neurol Sci 2024; 45:987-996. [PMID: 37851293 PMCID: PMC10858109 DOI: 10.1007/s10072-023-07126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023]
Abstract
The objective is to investigate the presentation, complications, management, and outcomes of copper deficiency-induced neurological pathologies due to Wilson disease (WD) overtreatment. We examined the case of a WD patient who developed a low thoracic dorsal myelopathy due to chronic hypocupremia from excessive zinc therapy. A comprehensive literature review was conducted to identify similar cases. Ten additional cases of neurological pathology resulting from copper deficiency in the context of WD over-treatment were identified, all occurring during therapy with zinc salts. Myelopathy and peripheral neuropathy were the most common complications, while two additional groups reported leukoencephalopathy. Early cytopenia was often associated with copper deficiency-related neurological pathology appearing early in the context of copper deficiency. WD patients undergoing treatment, especially with zinc salts, should be closely monitored to prevent over-treatment and the consequent copper deficiency. Regular complete blood counts could provide early detection of copper deficiency, avoiding irreversible neurological damage. Swift recognition of new neurological signs not consistent with WD and timely discontinuation of the decoppering therapy are critical for improving outcomes. The optimal management, including the potential benefit of copper supplementation in patients with WD and subsequent therapy adjustments, remains unclear and necessitates further investigation. Despite the general poor functional neurological outcomes, there were some exceptions that warrant further exploration.
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Affiliation(s)
- Danilo Tornabene
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Paola Bini
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Matteo Gastaldi
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Elisa Vegezzi
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Carlo Asteggiano
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | | | - Luca Diamanti
- IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
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Chevalier K, Obadia MA, Djebrani‐Oussedik N, Poujois A. Can Patients with Wilson's Disease Develop Copper Deficiency? Mov Disord Clin Pract 2023; 10:1306-1316. [PMID: 37772303 PMCID: PMC10525062 DOI: 10.1002/mdc3.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background Wilson's disease (WD) is a rare genetic condition characterized by a copper overload in organs secondary to mutation in ATP7B gene. Lifelong decoppering treatments are the keystone of the treatment but must be regularly adapted to obtain a correct copper balance and could lead to copper deficiency (CD). Objectives Study the characteristics of CD in WD patients. Methods CD cases from our cohort of 338 WD patients have been investigated. CD was defined by the association of serum copper, exchangeable copper and urinary copper excretion assays less than two standard deviations from the mean with cytopenia and/or neurological damage of spinal cord origin. A systematic review of literature about cases of CD in WD patient was performed in PubMed database according to PRISMA guidelines. Results Three WD patients were diagnosed with CD in our cohort. Review of the literature found 17 other patients. Most of the patients had anemia and neutropenia associated with neurological symptoms (especially progressive posterior cord syndrome). All the patients were treated with Zinc salts and the symptoms occurred more than a decade after the initiation of treatment. The adaptation of the treatment allowed a correction of the cytopenia but only a partial improvement of the neurological symptoms. Conclusions WD patients can develop CD after many years of zinc therapy. Anemia and neutropenia are red flags that should evoke CD.
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Affiliation(s)
- Kevin Chevalier
- Department of NeurologyRothschild Foundation HospitalParisFrance
- National Reference Center for Wilson's Disease and Other Copper‐Related Rare DiseasesRothschild Foundation HospitalParisFrance
| | - Mickaël Alexandre Obadia
- Department of NeurologyRothschild Foundation HospitalParisFrance
- National Reference Center for Wilson's Disease and Other Copper‐Related Rare DiseasesRothschild Foundation HospitalParisFrance
| | - Nouzha Djebrani‐Oussedik
- National Reference Center for Wilson's Disease and Other Copper‐Related Rare DiseasesRothschild Foundation HospitalParisFrance
- Toxicology LaboratoryLariboisière Hospital, APHPParisFrance
| | - Aurélia Poujois
- Department of NeurologyRothschild Foundation HospitalParisFrance
- National Reference Center for Wilson's Disease and Other Copper‐Related Rare DiseasesRothschild Foundation HospitalParisFrance
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Litwin T, Antos A, Bembenek J, Przybyłkowski A, Kurkowska-Jastrzębska I, Skowrońska M, Członkowska A. Copper Deficiency as Wilson's Disease Overtreatment: A Systematic Review. Diagnostics (Basel) 2023; 13:2424. [PMID: 37510170 PMCID: PMC10377829 DOI: 10.3390/diagnostics13142424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Treatment of Wilson's disease (WD), an inherited disease characterized by copper overload, is lifelong and there is the possibility that copper deficiency (CD) may occur. We systematically reviewed the literature to describe treatment patterns, symptoms and outcomes associated with CD. METHODS Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, the PubMed database was searched up to 6 April 2023. RESULTS Across 17 articles, 20 cases of CD were described, most commonly (15 cases) in WD patients treated with zinc salts (ZS), less often on combined chelator and ZS therapy (3 cases), molybdate salts plus ZS (1), or molybdate alone (1). CD symptoms occurred insidiously, including sideroblastic anemia, neutropenia, axonal sensory neuropathy, posterior cord myelopathy and increased ratio of epileptic seizures (or epilepsy). CD diagnosis was based on symptoms and severely reduced urinary copper excretion (<20 µg/24 h [<0.3 µmol/24 h] on ZS, or <100 µg/24 h [<1.6 µmol/24 h] on chelators) with low total serum copper and ceruloplasmin. CONCLUSIONS Awareness of CD and regular monitoring of copper metabolism is needed during WD treatment. Temporary cessation of anti-copper treatment usually reverses serum copper reductions as well as pancytopenia; however, some symptoms, especially neuropathy and myelopathy, may persist.
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Affiliation(s)
- Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland
| | - Jan Bembenek
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland
| | - Adam Przybyłkowski
- Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | - Marta Skowrońska
- Second Department of Neurology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland
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Ueda M, Katsuse K, Kakumoto T, Kobayashi S, Ishiura H, Mitsui J, Toda T. Copper Deficiency in Wilson's Disease with a Normal Zinc Value. Intern Med 2023; 62:1073-1076. [PMID: 36047117 PMCID: PMC10125822 DOI: 10.2169/internalmedicine.9366-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Copper deficiency (CD) is a rare complication of long-term treatment of Wilson's disease (WD) and is usually accompanied by high serum zinc levels. A 57-year-old woman with WD presented with limb weakness and sensory disturbance due to myeloneuropathy and macrocytic anemia after 36 years of treatment. Markedly reduced serum free copper values confirmed CD, which was considered to be caused by progressive dysphagia and severe diarrhea rather than zinc overdose because of the normal serum zinc levels. Discontinuing copper-reducing therapy and increasing copper intake improved her symptoms. Physicians should be alert for the risk of CD in WD patients, especially those with dysphagia.
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Affiliation(s)
- Masayuki Ueda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kazuto Katsuse
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Toshiyuki Kakumoto
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Satoshi Kobayashi
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Jun Mitsui
- Department of Molecular Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
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Leonard P, Louw A, Prentice D, Cirillo M. Clonal cytopenia of undetermined significance and atypical Behçet's: the importance of zinc. BMJ Case Rep 2022; 15:e247154. [PMID: 35351745 PMCID: PMC8966545 DOI: 10.1136/bcr-2021-247154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/03/2023] Open
Abstract
Atypical Behçet's is recognised in myelodysplastic syndrome (MDS) cases and is associated with trisomy 8. Clonal cytopenia of undetermined significance (CCUS) is recognised as a precursor to MDS. Our case describes the presentation of atypical Behçet's, in association with CCUS, post a Streptococcal infection. A mutation of a zinc finger RNA spliceosome, ZRSR2, is also described. Our patient initially presented with macrocytic anaemia, together with neutropenia and lymphocytopenia on routine monitoring. Later gastrointestinal symptoms together with oral and anal ulcerations developed. He was treated with oral zinc therapy and had resolution of recurrent oral ulcerations and significant reduction in severity of anal ulcerations. The functional impact of ZRSR2 mutation on spliceosome assembly is yet to be defined, but has been previously reported in CCUS with a clinical phenotype of macrocytic anaemia.
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Affiliation(s)
- Patricia Leonard
- School of Medicine, Curtin University, Bentley, Western Australia, Australia
| | - Alison Louw
- Molecular Haematology, PathWest Laboratory Medical WA, Murdoch, Western Australia, Australia
| | - David Prentice
- Neurology, Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Melita Cirillo
- Haematology, Royal Perth Hospital, Perth, Western Australia, Australia
- School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Clinical efficacy and safety of Gandouling plus low-dose D-penicillamine for treatment of Wilson's disease with neurological symptoms. J TRADIT CHIN MED 2018. [DOI: 10.1016/j.jtcm.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wazir SM, Ghobrial I. Copper deficiency, a new triad: anemia, leucopenia, and myeloneuropathy. J Community Hosp Intern Med Perspect 2017; 7:265-268. [PMID: 29046759 PMCID: PMC5637704 DOI: 10.1080/20009666.2017.1351289] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/30/2017] [Indexed: 01/08/2023] Open
Abstract
Clinical copper deficiency is now more frequently recognized. Hematologically, it can present as anemia (microcytic, normocytic, or macrocytic) and neutropenia. Thrombocytopenia is relatively rare. Neurologically, it can manifest as myelopathy and peripheral neuropathy simulating subacute combined degeneration. Bone marrow findings can mimic myelodysplasia resulting in occasional inappropriate referral for bone marrow transplantation. Other conditions with similar presentations include infections, drug toxicity, autoimmunity, B12 deficiency, folate deficiency, myelodysplastic syndrome, aplastic anemia, and lymphoma with bone marrow involvement. Hematological, but not neurological, manifestations respond promptly to copper replacement, making early diagnosis essential for good outcome. Common risk factors for copper deficiency are foregut surgery, dietary deficiency, enteropathies with malabsorption, and prolonged intravenous nutrition (total parenteral nutrition). We present a unique case of copper deficiency, with no apparent known risk factors.
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Affiliation(s)
- Shoaib M Wazir
- Department of Internal Medicine, UPMC Mercy Hospital, Pittsburgh, PA, USA
| | - Ibrahim Ghobrial
- UPMC McKeesport Hospital, Department of Medicine, McKeesport, PA, USA
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10
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Silva-Júnior FPD, Machado AAC, Lucato LT, Barbosa ER. Resolution of MRI findings of copper deficiency myeloneuropathy in a patient with Wilson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:255-6. [PMID: 24676446 DOI: 10.1590/0004-282x20130226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/22/2013] [Indexed: 11/21/2022]
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Dzieżyc K, Litwin T, Sobańska A, Członkowska A. Symptomatic copper deficiency in three Wilson's disease patients treated with zinc sulphate. Neurol Neurochir Pol 2014; 48:214-8. [PMID: 24981187 DOI: 10.1016/j.pjnns.2014.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/06/2014] [Indexed: 12/17/2022]
Abstract
Wilson's disease (WD) is caused by excess of copper that leads to accumulation of copper mainly in the liver, brain and needs life-long decoppering therapy. However, overtreatment with anti-copper agents may lead to copper deficiency which may cause neurological and hematological symptoms. Copper is an important cofactor for many enzymes. This report describes three WD patients with diagnosed copper deficiency during zinc sulphate (ZS) treatment. After 5-16 years of therapy all patients developed leucopenia. Spinal cord injury was manifested in two of the patients. One of them also presented myopathy. In conclusion, copper deficiency may occur in different time after treatment onset, therefore regular copper metabolism and hematological monitoring is necessary.
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Affiliation(s)
- Karolina Dzieżyc
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Sobańska
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland.
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13
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Verma R, Praharaj H, Khanna VK, Garg RK, Singh MK, Malhotra HS. Study of micronutrients (copper, zinc and vitamin B12) in posterolateral myelopathies. J Neurol Sci 2013; 329:11-6. [DOI: 10.1016/j.jns.2013.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/14/2013] [Accepted: 03/06/2013] [Indexed: 10/27/2022]
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14
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Recovery after copper-deficiency myeloneuropathy in Wilson’s disease. J Neurol 2013; 260:1917-8. [DOI: 10.1007/s00415-013-6963-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/05/2013] [Accepted: 05/10/2013] [Indexed: 12/22/2022]
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Bruguera M, Abraldes JG. [Common problems in the diagnosis and treatment of Wilson's disease]. GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:316-25. [PMID: 23570841 DOI: 10.1016/j.gastrohep.2012.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 12/16/2022]
Abstract
The present article aims to provide answers to questions frequently asked by physicians attending patients with Wilson's disease (WD) or those with a suspected diagnosis of WD. The article is divided into 2 parts: a first part with answers to questions relating to the diagnosis of this entity and a second with answers to questions concerning treatment. A brief appendix is included with responses to questions not falling into either of these 2 categories.
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Affiliation(s)
- Miguel Bruguera
- Servicio de Hepatología, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, España.
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Abstract
Neurotoxic disease can mimic many common neurologic disease states, including parkinsonism, myelopathy, neuropathy, and encephalopathy. Accurate diagnosis and appropriate treatment may result in a favorable outcome. This review highlights 5 areas of neurotoxicology for which there is an emerging understanding of disease processes or patterns of exposure, including 3 specific metal toxicities (manganism, zinc-induced copper deficiency, and cobalt-chromium neuropathy). Toxin-induced posterior reversible encephalopathy syndrome is more widely recognized and reported in association with an ever-growing list of drugs. Two new categories of street drugs, synthetic cathinones and cannabinoids, have been identified as public health threats due to their popularity, availability, and severity of toxicity.
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Affiliation(s)
- Laura M Tormoehlen
- Neurology and Emergency Medicine (LMT), Indiana University, Indianapolis; Neurology (NK), Mayo Clinic, Rochester, MN
| | - Neeraj Kumar
- Neurology and Emergency Medicine (LMT), Indiana University, Indianapolis; Neurology (NK), Mayo Clinic, Rochester, MN
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Weiss KH, Stremmel W. Evolving perspectives in Wilson disease: diagnosis, treatment and monitoring. Curr Gastroenterol Rep 2012; 14:1-7. [PMID: 22083169 DOI: 10.1007/s11894-011-0227-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Wilson disease (WD), the autosomal recessively inherited copper overload disorder, remains a diagnostic and therapeutic challenge. In the last decade, direct sequencing of the affected gene ATP7B became commercially available, but interpretation of the results still requires careful attention. Thus, a combination of tests reflecting the disturbed copper metabolism is needed to make the final diagnosis. Because of the low disease frequency, the existing treatment concepts are not based on controlled trails. Here, recent outcome reports of larger cohort studies challenge the recommended therapies and call for individualized treatment strategies. The notion, that certain medical regimens may either be insufficient to upkeep copper homeostasis or may lead to a clinically relevant overtreatment, demand a continuous monitoring of patients even after decades of therapy. In this article, we review current diagnostic and therapeutic approaches in WD.
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Affiliation(s)
- Karl Heinz Weiss
- University Hospital Heidelberg, Internal Medicine IV, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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da Silva-Júnior FP, Lucato LT, Machado AAC, Barbosa ER. Copper deficiency in Wilson's disease: an avoidable complication of treatment. Mov Disord 2011; 26:2448-9; author reply 2449-50. [PMID: 21956703 DOI: 10.1002/mds.23970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 08/25/2011] [Indexed: 11/09/2022] Open
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