1
|
Basal ganglia-orbitofrontal circuits are associated with prospective memory deficits in Wilson's disease. Brain Imaging Behav 2021; 16:141-150. [PMID: 34297310 DOI: 10.1007/s11682-021-00485-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
Degenerative changes in the basal ganglia (BG) are thought to contribute to neurological symptoms in Wilson's disease (WD). However, very little is known about whether and how the BG have an influence on prospective memory (PM) by interacting with the cerebral cortex. Here, we employed structural magnetic resonance imaging to systematically examine the effect of volume atrophy of BG on cortical thickness and to evaluate the relationships between cortical thickness of regions associated with BG atrophy and PM performance in WD. Cortical thickness atrophy in the left temporal pole and medial frontal gyrus are not related to degenerative changes in BG. Cortical thickness in the left superior frontal gyrus and right orbitofrontal gyrus (ORB) have stronger correlations with volume atrophy of the left accumbens, pallidum, and putamen in WD when compared with healthy controls. Furthermore, the cortical thickness of the right ORB is not only significantly correlated with PM performance but can also distinguish the severity of PM impairment in WD. Additionally, the middle cingulate cortex was related to volume atrophy of the accumbens, and its cortical thickness has a significant positive correlation with event-based PM. Together, these findings highlight that BG-orbitofrontal circuits may serve as neural biomarkers of PM and provide implications for the neural mechanisms underlying cognitive impairment in WD.
Collapse
|
2
|
Clinical significance of self-descriptive apathy assessment in patients with neurological form of Wilson's disease. Neurol Sci 2021; 43:1385-1394. [PMID: 34125323 PMCID: PMC8789726 DOI: 10.1007/s10072-021-05366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
Background and aim Apathy is one of the neuropsychiatric symptoms of Wilson’s disease (WD) which typically affects the brain’s fronto-basal circuits. Lack of agreed diagnostic criteria and common use of self-description assessment tools lead to underestimation of this clinical phenomenon. The aim of this study was to investigate whether subjective and informant-based clinical features of apathy in patients with WD enable clinicians to make a valid diagnosis. Methods Multiple aspects of goal-oriented behavior were assessed in 30 patients with the neurological form of WD and 30 age-matched healthy participants using two questionnaires, the Lille Apathy Rating Scale (LARS) and the Dysexecutive Questionnaire (DEX). Both included a self-descriptive and a caregiver/proxy version. Cognitive functioning was estimated with the use of Addenbrooke’s Cognitive Examination-Revised. Results Patients obtained significantly worse scores on all clinical scales when more objective measures were considered. Features of apathy and executive dysfunction were revealed in patients’ caregiver versions of LARS and DEX, which may indicate poor self-awareness of patients with WD. Roughly 30% of participants were likely to present with clinically meaningful symptoms, independent of cognitive dysfunction. Conclusions Methods relying on self-description appear inferior to informant-based scales when diagnosing apathy. More objective criteria and measurement tools are needed to better understand this clinical syndrome.
Collapse
|
3
|
Rossi M, Farcy N, Starkstein SE, Merello M. Nosology and Phenomenology of Psychosis in Movement Disorders. Mov Disord Clin Pract 2020; 7:140-153. [PMID: 32071931 PMCID: PMC7011839 DOI: 10.1002/mdc3.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/02/2019] [Accepted: 12/01/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychotic symptoms, such as delusions and hallucinations, are part of the clinical picture of several conditions presenting movement disorders. Phenomenology and epidemiology of psychosis in Parkinson's disease have received wide attention; however, the presence of psychosis in other movement disorders is, comparatively, less well known. OBJECTIVES To review psychotic symptoms present in different movement disorders. METHODS A comprehensive and structured literature search was performed to identify and analyze data on patients with movement disorders and comorbid psychosis. RESULTS In monogenic parkinsonisms, such as PARK-GBA, PARK-LRRK2, and PARK-SNCA, visual hallucinations related to dopamine replacement therapy are frequent as well as are delusions in PARK-LRRK2 and PARK-SNCA, but not in PARK-GBA. Different types of delusions and hallucinations are found in Huntington's disease and other choreic disorders. In Tourette's syndrome, paranoid delusions as well as visual, olfactory, and auditory hallucinations have been described, which usually develop after an average of 10 years of disease. Delusions in ataxias are more frequent in ATX-TBP, ATX-ATN1, and ATX-ATXN3, whereas it is rare in Friedreich's ataxia. Psychosis is also a prominent and frequent clinical feature in Fahr's disease, Wilson's disease, neurodegeneration with brain iron accumulation, and some lysosomal storage disorders, whereas it is uncommon in atypical parkinsonisms and dystonia. Psychosis usually occurs at late disease stages, but may appear as onset symptoms of the disease, especially in Wilson's disease, Huntington's disease, late-onset Tays-Sachs, and Niemann-Pick. CONCLUSION Psychosis is a frequent comorbidity in most hyper- and hypokinetic movement disorders. Appropriate recognition is relevant both in the early and late disease stages.
Collapse
Affiliation(s)
- Malco Rossi
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Pontificia Universidad Catolica Argentina (UCA)Buenos AiresArgentina
| | - Nicole Farcy
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Sergio E. Starkstein
- School of Psychiatry and Clinical NeurosciencesUniversity of Western AustraliaCrawleyWAAustralia
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Pontificia Universidad Catolica Argentina (UCA)Buenos AiresArgentina
- Argentine National Scientific and Technological Research Council (CONICET)Buenos AiresArgentina
| |
Collapse
|
4
|
Hu S, Wu H, Xu C, Wang A, Wang Y, Shen T, Huang F, Kan H, Li C. Aberrant Coupling Between Resting-State Cerebral Blood Flow and Functional Connectivity in Wilson's Disease. Front Neural Circuits 2019; 13:25. [PMID: 31057370 PMCID: PMC6482267 DOI: 10.3389/fncir.2019.00025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/25/2019] [Indexed: 12/17/2022] Open
Abstract
Both abnormalities of resting-state cerebral blood flow (CBF) and functional connectivity in Wilson’s disease (WD) have been identified by several studies. Whether the coupling of CBF and functional connectivity is imbalanced in WD remains largely unknown. To assess this possibility, 27 patients with WD and 27 sex- and age-matched healthy controls were recruited to acquire functional MRI and arterial spin labeling imaging data. Functional connectivity strength (FCS) and CBF were calculated based on standard gray mask. Compared to healthy controls, the CBF–FCS correlations of patients with WD were significantly decreased in the basal ganglia and the cerebellum and slightly increased in the prefrontal cortex and thalamus. In contrast, decreased CBF of patients with WD occurred predominately in subcortical and cognitive- and emotion-related brain regions, including the basal ganglia, thalamus, insular, and inferior prefrontal cortex, whereas increased CBF occurred primarily in the temporal cortex. The FCS decrease in WD patients was predominately in the basal ganglia and thalamus, and the increase was primarily in the prefrontal cortex. These findings suggest that aberrant neurovascular coupling in the brain may be a possible neuropathological mechanism underlying WD.
Collapse
Affiliation(s)
- Sheng Hu
- Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Hongli Wu
- Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - ChunSheng Xu
- Laboratory of Digital Medical Imaging, Medical Imaging Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Anqin Wang
- Laboratory of Digital Medical Imaging, Medical Imaging Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Yi Wang
- Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Tongping Shen
- Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Fangliang Huang
- Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Hongxing Kan
- Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, China
| | - Chuanfu Li
- Laboratory of Digital Medical Imaging, Medical Imaging Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| |
Collapse
|
5
|
Dusek P, Litwin T, Członkowska A. Neurologic impairment in Wilson disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S64. [PMID: 31179301 DOI: 10.21037/atm.2019.02.43] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neurologic symptoms in Wilson disease (WD) appear at an older age compared to hepatic symptoms and manifest in patients with misdiagnosed liver disease, in patients when the hepatic stage is clinically silent, in the case of non-compliance with anti-copper treatment, or with treatment failure. Neurologic symptoms in WD are caused by nervous tissue damage that is primarily a consequence of extrahepatic copper toxicity. Copper levels in brain tissues as well as cerebrospinal fluid (CSF) are diffusely increased by a factor of 10 and its toxicity involves various mechanisms such as mitochondrial toxicity, oxidative stress, cell membrane damage, crosslinking of DNA, and inhibition of enzymes. Excess copper is initially taken-up and buffered by astrocytes and oligodendrocytes but ultimately causes dysfunction of blood-brain-barrier and demyelination. Most severe neuropathologic abnormalities, including tissue rarefaction, reactive astrogliosis, myelin palor, and presence of iron-laden macrophages, are typically present in the putamen while other basal ganglia, thalami, and brainstem are usually less affected. The most common neurologic symptoms of WD are movement disorders including tremor, dystonia, parkinsonism, ataxia and chorea which are associated with dysphagia, dysarthria and drooling. Patients usually manifest with various combinations of these symptoms while purely monosymptomatic presentation is rare. Neurologic symptoms are largely reversible with anti-copper treatment, but a significant number of patients are left with residual impairment. The approach for symptomatic treatment in WD is based on guidelines for management of common movement disorders. The vast majority of WD patients with neurologic symptoms have abnormalities on brain magnetic resonance imaging (MRI). Pathologic MRI changes include T2 hyperintensities in the basal ganglia, thalami and white matter, T2 hypointensities in the basal ganglia, and atrophy. Most importantly, brain damage and neurologic symptoms can be prevented with an early initiation of anti-copper treatment. Introducing population WD screening, e.g., by exome sequencing genetic methods, would allow early treatment and decrease the neurologic burden of WD.
Collapse
Affiliation(s)
- Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia.,Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Tomasz Litwin
- 2nd Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- 2nd Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
| |
Collapse
|
6
|
Alkhalik Basha MA, Refaat R, Ahmed AF, Yousef HY, Alsowey AM, Metwally MI, Aly SA, Hussien HM, El-Saadany HF, AlGhobashy AA, Talat MA, Amer MM, Eid AM. Brain magnetic resonance spectroscopy (MRS) as a diagnostic tool for detecting early neurological changes in children with Wilson's disease. Eur J Radiol 2018; 111:41-46. [PMID: 30691663 DOI: 10.1016/j.ejrad.2018.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Although brain magnetic resonance spectroscopy (MRS) imaging findings in adult Wilson disease (WD) have been explained in extensive details, a paucity of information currently exists regarding brain MRS imaging findings in pediatric WD. The purpose of this study was to clarify the role of brain MRS in detecting early metabolite abnormalities in children with WD. PATIENT AND METHODS A case-controlled prospective study included 26 children with WD and 26 healthy controls. All children were subjected to examination on a 1.5 T MRI scanner. The spectra of N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr), as well as the metabolite ratios of NAA/Cho, NAA/Cr, and Cho/Cr, were measured and compared between two groups. RESULTS Eight patients revealed increased signal intensity in the basal ganglia at T1-weighted images. When compared with healthy controls, WD patients showed a significant decrease (p < 0.05) in NAA (63.8 ± 9.6 vs 97.6 ± 3.8), Cho (46.7 ± 8.9 vs 87.3 ± 4.7), Cr (44 ± 10.1 vs 81.9 ± 4.05), NAA/Cho (1.92 ± 1.2 vs 3.34 ± 0.55), NAA/Cr (1.29 ± 0.7 vs 2.46 ± 0.34), and Cho/Cr (0.78 ± 0.4 vs 2 ± 0.13). Patients complicated with liver cell failure showed a significant decrease in all previous parameters (p < 0.05) than patients without complications. Patients with mixed neurological and hepatic diseases showed a severe reduction in NAA, NAA/Cr, and NAA/Cho compared with patients with hepatic disease only. CONCLUSION MRS in pediatric WD detects early neurological changes even with normal MRI.
Collapse
Affiliation(s)
| | - Rania Refaat
- Department of Radio-diagnosis, Faculty of human medicine, Ain Shams University, Cairo, Egypt.
| | - Ayman F Ahmed
- Department of Radio-diagnosis, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Hala Y Yousef
- Department of Radio-diagnosis, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Ahmed Mohamed Alsowey
- Department of Radio-diagnosis, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Maha Ibrahim Metwally
- Department of Radio-diagnosis, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Sameh Abdelaziz Aly
- Department of Radio-diagnosis, Faculty of human medicine, Banha University, Banha, Egypt.
| | - Hatem M Hussien
- Department of Pediatrics, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Hosam F El-Saadany
- Department of Pediatrics, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Asghan A AlGhobashy
- Department of Pediatrics, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Mohamed A Talat
- Department of Pediatrics, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| | - Mona M Amer
- Department of Neurology, Faculty of human medicine, Zagazig University. Zagazig, Egypt.
| | - Ashraf Mahrous Eid
- Department of Ophthalmology, Faculty of human medicine, Zagazig University, Zagazig, Egypt.
| |
Collapse
|
7
|
Członkowska A, Litwin T, Chabik G. Wilson disease: neurologic features. HANDBOOK OF CLINICAL NEUROLOGY 2018; 142:101-119. [PMID: 28433096 DOI: 10.1016/b978-0-444-63625-6.00010-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Wilson disease (WD) is a neurodegenerative disorder, which presents as a spectrum of neurologic manifestations that includes tremor, bradykinesia, rigidity, dystonia, chorea, dysarthria, and dysphagia, together with a combination of neurologic symptoms that can easily lead to misdiagnosis. An early diagnosis of WD, and appropriate anticopper treatment, usually leads to a marked improvement in patient health. Conversely, delayed diagnosis can result in persistent pathology, which, left untreated, can ultimately prove lethal. The aim of this chapter is to present a detailed description of the neurologic features of WD, including their evaluation, together with relevant ophthalmologic examinations, brain neuroimaging, and other laboratory measurements that show the extent of the involvement of the nervous system.
Collapse
Affiliation(s)
- Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland.
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Grzegorz Chabik
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| |
Collapse
|
8
|
Abstract
Wilson's disease (WD) is a relatively rare autosomal recessive inherited disorder causing copper accumulation in different organs, mainly the liver and brain. Psychiatric disturbances represent a diagnostic and therapeutic issue in WD. A search for relevant articles was carried out on PubMed/Medline, Scopus, and Google Scholar, for papers focused on psychiatric disorders in WD published between 1985-2016. Ninety-two articles were included in this review, showing the findings from 35 observational and case-control studies and 57 case reports. This study discussed the findings on the prevalence of psychiatric symptoms in WD, their impact on the life of those diagnosed, and the efficacy of available treatments on the psychiatric outcomes of WD. Psychiatric disorders are confirmed frequent in WD, with a high prevalence of mood disorders, and contribute to worse Quality-of-Life and psychosocial outcomes. Because specific therapies for WD lead to a good life expectancy, adherence to medicaments and clinical monitoring should be warranted by a multidisciplinary approach, including a hepathologic, neurologic, and psychiatric careful evaluation and education of those affected and their relatives.
Collapse
Affiliation(s)
- Gioia Mura
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Paula C Zimbrean
- b Department of Psychiatry and Surgery (Transplant) , Yale University , New Haven , CT , USA
| | - Luigi Demelia
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Mauro G Carta
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| |
Collapse
|
9
|
Hu X, Chen S, Huang CB, Qian Y, Yu Y. Frequency-dependent changes in the amplitude of low-frequency fluctuations in patients with Wilson's disease: a resting-state fMRI study. Metab Brain Dis 2017; 32:685-692. [PMID: 28116563 PMCID: PMC5418320 DOI: 10.1007/s11011-016-9946-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 12/26/2016] [Indexed: 12/29/2022]
Abstract
To investigate the frequency-dependent changes in the amplitude of low-frequency fluctuations (ALFF) in patients with Wilson's disease (WD). Resting-state function magnetic resonance imaging (R-fMRI) were employed to measure the amplitude of ALFF in 28 patients with WD and 27 matched normal controls. Slow-5 (0.01-0.027 Hz) and slow-4 (0.027-0.073 Hz) frequency bands were analyzed. Apart from the observation of atrophy in the cerebellum, basal ganglia, occipital gyrus, frontal gyrus, precentral gyrus, and paracentral lobule, we also found widespread differences in ALFF of the two bands in the medial frontal gyrus, inferior temporal gyrus, insula, basal ganglia, hippocampus/parahippocampal gyrus, and thalamus bilaterally. Compared to normal controls, WD patients had increased ALFF in the posterior lobe of the cerebellum, inferior temporal gyrus, brain stem, basal ganglia, and decreased ALFF in the anterior lobe of the cerebellum and medial frontal gyrus. Specifically, we observed that the ALFF abnormalities in the cerebellum and middle frontal gyrus were greater in the slow-5 than in the slow-4 band. Correlation analysis showed consistently positive correlations between urinary copper excretion (Cu), serum ceruloplasmin (CP) and ALFFs in the cerebellum. Our study suggests the accumulation of copper profoundly impaired intrinsic brain activity and the impairments seem to be frequency-dependent. These results provide further insights into the understanding of the pathophysiology of WD.
Collapse
Affiliation(s)
- Xiaopeng Hu
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Siyi Chen
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
- Department Psychologie, Ludwig-Maximilians-Universität, 80802, Munich, Germany
| | - Chang-Bing Huang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Yinfeng Qian
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
| | - Yongqiang Yu
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
| |
Collapse
|
10
|
Nonmotor Manifestations of Wilson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1443-1459. [DOI: 10.1016/bs.irn.2017.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
11
|
Abstract
Clinical presentation of Wilson disease can vary widely; therefore diagnosis is not always straightforward. Wilson disease is not just a disease of children and young adults, but may present at any age. The key features of Wilson disease are liver disease and cirrhosis, neuropsychiatric disturbances, Kayser-Fleischer rings, and acute episodes of hemolysis, often in association with acute liver failure. Diagnosis is particularly difficult in children and in adults presenting with active liver disease. None of the available laboratory tests is perfect and may not be specific for Wilson disease. A detailed neurologic examination is required for all cases. Neuroimaging and electrophysiologic methods are helpful. To overcome the diagnostic challenge, several clinical signs (Kayser-Fleischer rings, neurologic symptoms) and laboratory features (copper in serum, urine, liver; serum ceruloplasmin; genetic testing) are scored 0 (absent) to 2 (present) and the Leipzig score is calculated. If the score is ≥4, the diagnosis of Wilson disease is very likely. For asymptomatic siblings of index patients, mutation analysis is the most reliable approach.
Collapse
|
12
|
Kim S, Song IU, Chung YA, Choi EK, Oh JK. Brain MRI, Tc-99m HMPAO SPECT and F-18 FP-CIT PET/CT Findings in a Patient with Wilson Disease: A Case Report. Nucl Med Mol Imaging 2015; 48:303-5. [PMID: 26396635 DOI: 10.1007/s13139-014-0290-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 11/28/2022] Open
Abstract
A 34-year-old female had experienced head and hand tremors with a dystonic component for 8 months. Brain MRI showed T2 high signal intensity in the periaqueductal region, dorsal midbrain and dorsal upper pons. No abnormal uptake was noted on Tc-99m HMPAO SPECT or F-18 FP-CIT PET/CT. Wilson disease was diagnosed according to the 2008 consensus guideline from the American Association for the Study of Liver Disease and 2012 guideline from the European Association for the Study of the Liver. This case demonstrates T2 signal change in the basal ganglia, excluding the putamen, in a Wilson disease patient with relatively severe clinical findings, but normal Tc-99m HMPAO SPECT and F-18 FP-CIT PET/CT.
Collapse
Affiliation(s)
- Seungyoo Kim
- Department of Neurology, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Republic of Korea
| | - In Uk Song
- Department of Neurology, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Republic of Korea
| | - Yong An Chung
- Department of Radiology, The Catholic University of Korea, Incheon St. Mary's Hospital, #56 Dongsuro, Bupyeong-gu, Incheon, Republic of Korea 403-720
| | - Eun Kyung Choi
- Department of Radiology, The Catholic University of Korea, Incheon St. Mary's Hospital, #56 Dongsuro, Bupyeong-gu, Incheon, Republic of Korea 403-720
| | - Jin Kyoung Oh
- Department of Radiology, The Catholic University of Korea, Incheon St. Mary's Hospital, #56 Dongsuro, Bupyeong-gu, Incheon, Republic of Korea 403-720
| |
Collapse
|
13
|
Carta MG, Saba L, Moro MF, Demelia E, Sorbello O, Pintus M, Pintus E, Simavorian T, Akiskal H, Demelia L. Homogeneous magnetic resonance imaging of brain abnormalities in bipolar spectrum disorders comorbid with Wilson's disease. Gen Hosp Psychiatry 2015; 37:134-8. [PMID: 25772945 DOI: 10.1016/j.genhosppsych.2015.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND The purpose was to determine if brain damage in Wilson's disease (WD) is different in comorbid bipolar spectrum disorders (BDs), comorbid major depressive disorder (MDD) or without any mood disorders. METHODS An observational study was conducted on consecutive patients from a center for WD care. The study sample was divided by psychiatric assessment into WD without any mood disorders, WD with BDs and WD with MDD negative at Mood Disorder Questionnaire (MDQ). RESULTS Thirty-eight WD patients were recruited (53.2% females): 21 without mood disorders (55.2%), 9 with comorbid BDs (26.7%) and 8 with MDD without MDQ+ (21.1%). The BDs showed a higher frequency of brain damage, reaching statistically significant differences in the basal ganglia (P<.001), in the overall brain (P<.003) and at the limit in the white matter (P<.05). CONCLUSIONS In WD, comorbidity with BDs is associated with earlier evidence of brain damage, especially in the basal ganglia. The results confirm the importance of screening and early diagnosis of BDs in WD. Future follow-up studies on large samples are required to confirm if detection of BDs may be an early marker of brain damage and if a good therapeutic response in BDs may improve the prognosis of WD.
Collapse
Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari, Italy, Cagliari, Italy.
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato s.s. 554 Monserrato, Cagliari, 09045, Italy.
| | - Maria Francesca Moro
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari, Italy, Cagliari, Italy.
| | - Enrico Demelia
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato s.s. 554 Monserrato, Cagliari, 09045, Italy.
| | - Orazio Sorbello
- UOC of Gastroenterology, Azienda Ospedaliero - Universitaria, Cagliari, Italy.
| | - Mirra Pintus
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari, Italy, Cagliari, Italy.
| | - Elisa Pintus
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari, Italy, Cagliari, Italy.
| | | | - Hagop Akiskal
- International Mood Center, University of CA, San Diego, USA.
| | - Luigi Demelia
- UOC of Gastroenterology, Azienda Ospedaliero - Universitaria, Cagliari, Italy.
| |
Collapse
|
14
|
Abstract
Wilson disease is a genetic disorder of hepatic copper excretion leading to copper accumulation in various tissues. The disease expression is highly variable, ranging from totally asymptomatic subjects to patients with severe liver disease or movement disorders. Thus, it is difficult to define in which patient Wilson disease has to be considered as diagnosis. The suspicion should be high in patients presenting with extrapyramidal disorders or with liver diseases or of unknown origin. For diagnosis, in many patients a combination of tests reflecting disturbed copper metabolism may be needed. Not a single test is per se specific and, thus, a range of tests has to be applied (presence or absence of Kayser-Fleischer rings or neurologic symptoms, serum ceruloplasmin, liver copper content, urinary copper excretion, mutation analysis; rated -1 to 4 depending on the test) and clinical symptoms. A diagnostic sum score of ≥ 4 confirms the diagnosis.
Collapse
Affiliation(s)
- Peter Ferenci
- Department of Gastroenterology and Hepatology, Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria +43 140 400 4945 +43 140 400 4735
| |
Collapse
|
15
|
Walterfang M, van de Warrenburg BP. Cognitive impairment in “Other” movement disorders: Hidden defects and valuable clues. Mov Disord 2014; 29:694-703. [DOI: 10.1002/mds.25849] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/24/2014] [Accepted: 01/27/2014] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mark Walterfang
- Neuropsychiatry Unit; Royal Melbourne Hospital; Melbourne Australia
- Melbourne Neuropsychiatry Center; University of Melbourne; Melbourne Australia
| | - Bart P. van de Warrenburg
- Department of Neurology; Donders Institute of Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
| |
Collapse
|
16
|
Li G, Zhou X, Xu P, Pan X, Chen Y. Microstructure assessment of the thalamus in Wilson's disease using diffusion tensor imaging. Clin Radiol 2014; 69:294-8. [DOI: 10.1016/j.crad.2013.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/17/2013] [Accepted: 10/22/2013] [Indexed: 12/13/2022]
|
17
|
Zimbrean PC, Schilsky ML. Psychiatric aspects of Wilson disease: a review. Gen Hosp Psychiatry 2014; 36:53-62. [PMID: 24120023 DOI: 10.1016/j.genhosppsych.2013.08.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/14/2013] [Accepted: 08/29/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review the current evidence about psychiatric symptoms in Wilson's disease (WD). METHOD We searched Ovid, PsychInfo, CINHAL and PubMed databases from May 1946 to May 2012 using the key words Wilson('s) disease in combination with psychiatry, psychiatric, psychosis, schizophrenia, depression, mania, bipolar, mood, anxiety, personality and behavior. RESULTS Psychiatric symptoms occur before, concurrent with or after the diagnosis and treatment for WD. Thirty to forty percent of patients have psychiatric manifestations at the time of diagnosis, and 20% had seen a psychiatrist prior to their WD diagnosis. When psychiatric symptoms preceded neurological or hepatic involvement, the average time between the psychiatric symptoms and the diagnosis of WD was 864.3 days. The prevalence of psychiatric disorders in WD patients varies wildly (major depressive disorder, 4-47%; psychosis, 1.4-11.3%). Certain gene mutations of ATP7B may correlate with specific personality traits. CONCLUSIONS Psychiatric manifestations represent a significant part of the clinical presentation of WD and can present at any point in the course of the illness. Psychiatric manifestations occurring without overt hepatic or neurologic involvement may lead to misdiagnosis. A better understanding of the psychiatric presentations in WD may provide insights into the underlying mechanisms of psychiatric disorders.
Collapse
Affiliation(s)
- Paula C Zimbrean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Wilson Disease Centers of Excellence at Yale University, New Haven, CT.
| | - Michael L Schilsky
- Wilson Disease Centers of Excellence at Yale University, New Haven, CT; Section of Digestive Disease and Transplant and Immunology, Yale University School of Medicine; Yale Transplantation Center, Yale New Haven Hospital, New Haven, CT
| |
Collapse
|
18
|
Wenisch E, De Tassigny A, Trocello JM, Beretti J, Girardot-Tinant N, Woimant F. Cognitive profile in Wilson's disease: a case series of 31 patients. Rev Neurol (Paris) 2013; 169:944-9. [PMID: 24120329 DOI: 10.1016/j.neurol.2013.06.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/29/2013] [Accepted: 06/04/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Wilson's disease (WD) is a rare autosomal recessive disorder of copper metabolism. If untreated, WD, which is initially a liver disease, can turn into a multi-systemic disease with neurological involvement. Very few studies have described cognitive impairment in WD. The aim of this study is to report the cognitive profile of 31 treated WD patients. METHODS Patients were classed into two groups using the Unified Wilson Disease Rating Scale (UWDRS): WD patients without neurological signs (WD-N(-)) (n=13), and WD patients with neurological signs (WD-N(+)) (n=18). The patients participated in a neuropsychological assessment evaluating memory, executive function and visuo-spatial abilities. RESULTS Both groups performed well for verbal intelligence and episodic memory skills. However, the majority of these patients exhibited altered performance for at least one cognitive test, particularly in the executive domain. The WD-N(+) group performed less well than the WD-N(-) group on cognitive tests involving rapid motor function, abstract thinking, working memory and top-down inhibitory control. CONCLUSIONS Cognitive impairment in treated WD patients essentially affects executive function involving fronto-striatal circuits. Verbal intelligence and episodic memory abilities seem to be remarkably preserved. Neuropsychological assessment is a valuable tool to evaluate the presence and the consequences of these cognitive impairments in WD patients with or without neurological signs in the course of this chronic disease.
Collapse
Affiliation(s)
- E Wenisch
- French national reference centre for Wilson's disease, neurology department, Lariboisière hospital, 2, rue Ambroise-Paré, 75010 Paris cedex 10, France.
| | | | | | | | | | | |
Collapse
|
19
|
Hayhow BD, Hassan I, Looi JCL, Gaillard F, Velakoulis D, Walterfang M. The neuropsychiatry of hyperkinetic movement disorders: insights from neuroimaging into the neural circuit bases of dysfunction. Tremor Other Hyperkinet Mov (N Y) 2013; 3:tre-03-175-4242-1. [PMID: 24032090 PMCID: PMC3760049 DOI: 10.7916/d8sn07pk] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/08/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Movement disorders, particularly those associated with basal ganglia disease, have a high rate of comorbid neuropsychiatric illness. METHODS We consider the pathophysiological basis of the comorbidity between movement disorders and neuropsychiatric illness by 1) reviewing the epidemiology of neuropsychiatric illness in a range of hyperkinetic movement disorders, and 2) correlating findings to evidence from studies that have utilized modern neuroimaging techniques to investigate these disorders. In addition to diseases classically associated with basal ganglia pathology, such as Huntington disease, Wilson disease, the neuroacanthocytoses, and diseases of brain iron accumulation, we include diseases associated with pathology of subcortical white matter tracts, brain stem nuclei, and the cerebellum, such as metachromatic leukodystrophy, dentatorubropallidoluysian atrophy, and the spinocerebellar ataxias. CONCLUSIONS Neuropsychiatric symptoms are integral to a thorough phenomenological account of hyperkinetic movement disorders. Drawing on modern theories of cortico-subcortical circuits, we argue that these disorders can be conceptualized as disorders of complex subcortical networks with distinct functional architectures. Damage to any component of these complex information-processing networks can have variable and often profound consequences for the function of more remote neural structures, creating a diverse but nonetheless rational pattern of clinical symptomatology.
Collapse
Affiliation(s)
- Bradleigh D. Hayhow
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia
| | - Islam Hassan
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
| | - Jeffrey C. L. Looi
- Academic Unit of Psychiatry & Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia
| | | | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia
| |
Collapse
|
20
|
Abstract
This Clinical Practice Guideline (CPG) has been developed to assist physicians and other healthcare providers in the diagnosis and management of patients with Wilson's disease. The goal is to describe a number of generally accepted approaches for diagnosis, prevention, and treatment of Wilson's disease. Recommendations are based on a systematic literature review in the Medline (PubMed version), Embase (Dialog version), and the Cochrane Library databases using entries from 1966 to 2011. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system used in other EASL CPGs was used and set against the somewhat different grading system used in the AASLD guidelines (Table 1A and B). Unfortunately, there is not a single randomized controlled trial conducted in Wilson's disease which has an optimal design. Thus, it is impossible to assign a high or even a moderate quality of evidence to any of the questions dealt with in these guidelines. The evaluation is mostly based on large case series which have been reported within the last decades.
Collapse
|
21
|
Ishida S, Doi Y, Yamane K, Sugino M, Kimura F, Hanafusa T, Fukui H, Tamai H. Resolution of cranial MRI and SPECT abnormalities in a patient with Wilson's disease following oral zinc monotherapy. Intern Med 2012; 51:1759-63. [PMID: 22790141 DOI: 10.2169/internalmedicine.51.7341] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 38-year-old woman with Wilson's disease developed neurological deterioration after 25 years of low-dose penicillamine administration. She showed an akinetic-rigid syndrome and cerebellar motor ataxia. Brain MRI showed increased signal intensity at the bilateral pons, midbrain, putamen, and thalamus. 123I-IMP-SPECT revealed a diffuse reduction of cerebral blood flow at the bilateral cerebral hemisphere including the basal ganglia. After the patient's regimen was changed to zinc therapy, her neurological condition gradually improved, and she showed almost complete recovery within two years. Serial MRI and SPECT studies showed a marked improvement in the lesions.
Collapse
Affiliation(s)
- Shimon Ishida
- The First Department of Internal Medicine, Osaka Medical College, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Burgos A, Bermejo PE. [Neurological complications of Wilson's disease]. Med Clin (Barc) 2011; 137:419-23. [PMID: 21596401 DOI: 10.1016/j.medcli.2011.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 02/20/2011] [Accepted: 02/22/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Aurora Burgos
- Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | | |
Collapse
|
23
|
Abstract
The role for neuroimaging in the management of patients with tremor is gradually increasing, particularly with respect to stereotactic neurosurgery and deep brain stimulation where less than 2-mm tolerance is required for accurate electrode placement. The routine use of single photon emission CT technology to image the nigrostriatal dopaminergic system is proving helpful in distinguishing essential and dystonic tremors from neurodegenerative forms of parkinsonism and in improving our understanding of the pathophysiology of rarer tremors.
Collapse
|
24
|
Abstract
Wilson's disease (WD) or hepatolenticular degeneration is a rare, genetic and
systemic disease, caused by a deficit in the metabolism of copper, leading to
its accumulation in different organs, mainly the liver, followed by the central
nervous system, especially the basal ganglia. When symptoms begin between the
second and third decades of life, approximately 50% of the patients show
neurological symptoms. Although dystonia and dysarthria are the most common
neurological signs, cognitive changes have been reported since the first cases
were described in 1912. Memory change is one of the most common impairments, but
other cognitive changes have been reported, including dementia in untreated
cases. In this article we review the cognitive changes in WD patients and the
occurrence of dementia.
Collapse
Affiliation(s)
- Norberto Anizio Ferreira Frota
- MD, General Hospital of Fortaleza and Department of Neurology, University of São Paulo School Medicine, São Paulo, SP, Brazil
| | - Paulo Caramelli
- MD, PhD, Behavioral and Cognitive Neurology Unit Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Egberto Reis Barbosa
- MD, PhD, Department of Neurology, University of São Paulo School Medicine, São Paulo, SP, Brazil
| |
Collapse
|