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Schilsky ML, Roberts EA, Bronstein JM, Dhawan A, Hamilton JP, Rivard AM, Washington MK, Weiss KH, Zimbrean PC. A multidisciplinary approach to the diagnosis and management of Wilson disease: Executive summary of the 2022 Practice Guidance on Wilson disease from the American Association for the Study of Liver Diseases. Hepatology 2023; 77:1428-1455. [PMID: 36152019 DOI: 10.1002/hep.32805] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 12/08/2022]
Affiliation(s)
- Michael L Schilsky
- Medicine and Surgery , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Eve A Roberts
- Paediatrics, Medicine, Pharmacology and Toxicology , University of Toronto , Toronto , Ontario , Canada
| | - Jeff M Bronstein
- Neurology , University of California Los Angeles , Los Angeles , California , USA
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre and MowatLabs , King's College Hospital , London , UK
| | - James P Hamilton
- Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Anne Marie Rivard
- Food and Nutrition Services , Yale New Haven Hospital , New Haven , Connecticut , USA
| | - Mary Kay Washington
- Pathology, Immunology and Microbiology , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | | | - Paula C Zimbrean
- Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA
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2
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Jopowicz A, Tarnacka B. Neurological Wilson's Disease Signs-Hepatic Encephalopathy or Copper Toxicosis? Diagnostics (Basel) 2023; 13:diagnostics13050893. [PMID: 36900037 PMCID: PMC10001333 DOI: 10.3390/diagnostics13050893] [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: 01/27/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/03/2023] Open
Abstract
Wilson's disease (WD) is a rare autosomal recessive (AR) disorder resulting from mutations in the ATP7B gene, which is responsible for the encryption of transmembrane copper transporting ATPase. The symptomatic presentation of the disease is estimated to be about 1 in 30,000. The impairment of ATP7B function results in a copper overload in hepatocytes, which further leads to liver pathology. This copper overload also occurs in other organs, most particularly in the brain. This could then cause the occurrence of neurological and psychiatric disorders. Symptoms differ substantially and most often occur between the ages of 5 and 35 years. Early symptoms are commonly hepatic, neurological, or psychiatric. While disease presentation is most often asymptomatic, it could also range as far as to include fulminant hepatic failure, ataxia, and cognitive disorders. Various treatments are available for Wilson's disease, including chelation therapy and zinc salts, which can reverse copper overload through different mechanisms. In select cases, liver transplantation is recommended. New medications, such as tetrathiomolybdate salts, are currently being investigated in clinical trials. With prompt diagnosis and treatment, prognosis is favorable; however, diagnosing patients before the onset of severe symptoms is a significant concern. Early screening for WD could help in diagnosing patients earlier and improving treatment outcomes.
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Affiliation(s)
- Anna Jopowicz
- Department of Rehabilitation, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland
- Correspondence:
| | - Beata Tarnacka
- Department of Rehabilitation Medicine, Faculty of Medicine, Warsaw Medical University, Spartańska 1, 02-637 Warsaw, Poland
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Tian L, Dong T, Hu S, Zhao C, Yu G, Hu H, Yang W. Radiomic and clinical nomogram for cognitive impairment prediction in Wilson's disease. Front Neurol 2023; 14:1131968. [PMID: 37188313 PMCID: PMC10177658 DOI: 10.3389/fneur.2023.1131968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/30/2023] [Indexed: 05/17/2023] Open
Abstract
Objective To investigate potential biomarkers for the early detection of cognitive impairment in patients with Wilson's disease (WD), we developed a computer-assisted radiomics model to distinguish between WD and WD cognitive impairment. Methods Overall, 136 T1-weighted MR images were retrieved from the First Affiliated Hospital of Anhui University of Chinese Medicine, including 77 from patients with WD and 59 from patients with WD cognitive impairment. The images were divided into training and test groups at a ratio of 70:30. The radiomic features of each T1-weighted image were extracted using 3D Slicer software. R software was used to establish clinical and radiomic models based on clinical characteristics and radiomic features, respectively. The receiver operating characteristic profiles of the three models were evaluated to assess their diagnostic accuracy and reliability in distinguishing between WD and WD cognitive impairment. We combined relevant neuropsychological test scores of prospective memory to construct an integrated predictive model and visual nomogram to effectively assess the risk of cognitive decline in patients with WD. Results The area under the curve values for distinguishing WD and WD cognitive impairment for the clinical, radiomic, and integrated models were 0.863, 0.922, and 0.935 respectively, indicative of excellent performance. The nomogram based on the integrated model successfully differentiated between WD and WD cognitive impairment. Conclusion The nomogram developed in the current study may assist clinicians in the early identification of cognitive impairment in patients with WD. Early intervention following such identification may help improve long-term prognosis and quality of life of these patients.
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Affiliation(s)
- Liwei Tian
- Graduate School, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Ting Dong
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
- Key Laboratory of Xin’An Medicine, Ministry of Education, Hefei, Anhui, China
- *Correspondence: Ting Dong,
| | - Sheng Hu
- Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Chenling Zhao
- Graduate School, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Guofang Yu
- Graduate School, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Huibing Hu
- Qimen People's Hospital, Huangshan, Anhui, China
| | - Wenming Yang
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
- Key Laboratory of Xin’An Medicine, Ministry of Education, Hefei, Anhui, China
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4
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Schilsky ML, Roberts EA, Bronstein JM, Dhawan A, Hamilton JP, Rivard AM, Washington MK, Weiss KH, Zimbrean PC. A multidisciplinary approach to the diagnosis and management of Wilson disease: 2022 Practice Guidance on Wilson disease from the American Association for the Study of Liver Diseases. Hepatology 2022:01515467-990000000-00207. [PMID: 36151586 DOI: 10.1002/hep.32801] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Michael L Schilsky
- Medicine and Surgery , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Eve A Roberts
- Paediatrics, Medicine, Pharmacology and Toxicology , University of Toronto , Toronto , Ontario , Canada
| | - Jeff M Bronstein
- Neurology , University of California Los Angeles , Los Angeles , California , USA
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre and MowatLabs , King's College Hospital , London , UK
| | - James P Hamilton
- Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Anne Marie Rivard
- Food and Nutrition Services , Yale New Haven Hospital , New Haven , Connecticut , USA
| | - Mary Kay Washington
- Pathology, Immunology and Microbiology , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | | | - Paula C Zimbrean
- Psychiatry , Yale University School of Medicine , New Haven , Connecticut , USA
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5
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Fortea A, Pinzón-Espinosa J, Ilzarbe D, Espinosa L, Lázaro L, Calvo RM, Castro-Fornieles J, de la Serna E, Bargalló N, Baeza I, Sugranyes G. Radiological findings in brain MRI scans in youth with early-onset psychosis: A controlled study. J Psychiatr Res 2022; 156:151-158. [PMID: 36252344 DOI: 10.1016/j.jpsychires.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/08/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
There is a lack of consensus on whether routine brain magnetic resonance imaging (MRI) should be recommended as part of the initial assessment in patients with psychosis. No study so far has qualitatively assessed brain MRI in patients with early-onset psychosis (EOP), in whom neurodevelopmental factors may play a stronger role. We aimed to determine the prevalence of brain MRI findings in patients with EOP compared to healthy controls, and assess whether these findings were clinically relevant. Retrospective clinical chart review of all patients with EOP in whom a brain MRI scan was acquired during admission to an inpatient child and adolescent psychiatry unit during January 2013-December 2017, compared to age and biologically assigned gender matched healthy controls. Between group analyses tested differences in rates of qualitatively abnormal MRI scans and changes in clinical management as a result of radiological findings. A total of 256 individuals were included (128 patients with EOP and 128 healthy controls). Patients with EOP presented with a significantly higher rate of abnormal MRI scans relative to healthy controls (21.9% vs 11.7%, p = .030; OR = 2.11, [95% CI:1.06-4.17]). Radiological findings in the EOP group triggered clinical referral for further evaluation or management more often than in the healthy control group (7.0% vs 1.6%, p = .030; OR = 4.76, [95% CI:1.01-22.50]). MRI scans in youth with EOP may be characterized by an increased number of radiological abnormalities than in controls. The rates of MRI findings requiring clinical referral suggests that routine MRI acquisition may need to be considered in patients with EOP.
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Affiliation(s)
- Adriana Fortea
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; Fundació Clínic per a La Recerca Biomèdica (FCRB), 153 Rosselló St., Barcelona, 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Justo Pinzón-Espinosa
- Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Mental Health, Parc Tauli University Hospital, Sabadell, 1 Parc Taulí, Sabadell, 08208, Barcelona, Spain; Department of Clinical Psychiatry, School of Medicine, University of Panama, Ave. Octavio Méndez Pereira, Panamá, XFJ8+V2Q, Panama
| | - Daniel Ilzarbe
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Laura Espinosa
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Child and Adolescent Psychiatry, Hospital Sant Joan de Deu, Fundació Althaia, 1-3 Dr. Joan Soler St., Manresa, 08243, Barcelona, Spain
| | - Luisa Lázaro
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Rosa M Calvo
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Nuria Bargalló
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Department of Radiology, Imaging Diagnosis Center, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Department of Medicine, School of Medicine, University of Barcelona, 143 Casanova St Barcelona 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR-881 Institute of Neuroscience, Hospital Clínic of Barcelona, 170 Villarroel St., Barcelona, 08036, Spain; Fundació Clínic per a La Recerca Biomèdica (FCRB), 153 Rosselló St., Barcelona, 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 153 Rosselló St., Barcelona, 08036, Spain; Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 3-5, Monforte de Lemos St., Madrid, 28029, Spain.
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Voloshyna D, Bseiso A, Shaik TA, Sedhai S, Abdelsamad A, Khan MH, Sandhu QI, Saleem F, Ghaffari MAZ. Rapid Eye Movement Behavior Sleep Disorder as a Primary Manifestation of Wilson Disease: A Gateway to Early Intervention. Cureus 2022; 14:e29618. [PMID: 36312644 PMCID: PMC9595345 DOI: 10.7759/cureus.29618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/11/2022] Open
Abstract
Wilson's disease (WD) is one of the most prevalent genetic conditions in the world. The average onset age ranges between 5 and 35 years. The prognosis tends to be worse if the diagnosis is delayed. Neurocognitive and psychological disorders are the most common extrahepatic manifestations of WD. Moreover, rapid eye movement (REM) sleep behavior disorder (RBD) is discovered to have a significant correlation with neurodegenerative disorders, particularly WD. Several synucleinopathies, including WD, have an early prodromal stage that manifests as RBD or sleep behavior disorder. We hereby present a case of a 14-year-old patient with borderline ceruloplasmin levels and REM sleep disorder as an early manifestation of WD. RBD may be considered one of the earliest manifestations of such disorders and a vital phase of the disease's onset, as the patient may be more responsive to treatment at this point.
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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.
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Cochen De Cock V, Lacombe S, Woimant F, Poujois A. Sleep disorders in Wilson's disease. Sleep Med 2020; 83:299-303. [PMID: 34077903 DOI: 10.1016/j.sleep.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND/OBJECTIVES Wilson's disease (WD) is a rare genetic disorder that leads to copper overload, mainly in the liver then, in the brain. Patients with WD often complain about sleep disorders. We aimed to explore them. PATIENTS/METHODS Sleep complaints and disease symptoms were compared in 40 patients with WD (20 patients with hepatic phenotype matched to 20 neurologic one) and 40 age, sex and BMI matched healthy controls. RESULTS Patients with WD had more frequently (32.5 vs 10.0%, p < 0.05) and more severe (10.5 ± 6.0 vs 7.6 ± 4.8, p < 0.01) insomnia than controls and insomnia was more severe in neurologic than hepatic form of the disease (12.25 ± 5.89 vs 8.73 ± 5.8, p < 0.05). Insomnia severity was correlated with the severity of depressive symptoms (r = 0.53, p < 0.001). Compared to controls, patients reported more difficulties staying asleep and more consequences of insomnia on their quality of life. REM sleep behavior disorder was more frequent in WD (20 vs 0%, p = 0.005) than controls. Patients complained more frequently of nycturia (22.8 vs 7.6%, p = 0.003) than controls. Patients did not differ from controls for sleepiness, restless legs syndrome and obstructive sleep apnea syndrome. Patients did not report cataplexia. CONCLUSION In patients with WD, insomnia and REM sleep behavior disorder are the two main sleep complaints. Insomnia is more frequent in neurologic than hepatic form of the disease. Severity of insomnia is associated with the severity of depressive symptoms.
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Affiliation(s)
- Valérie Cochen De Cock
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France; EuroMov, Digital Health in Motion, University of Montpellier IMT Mines Ales, Montpellier, France.
| | - Sandy Lacombe
- Sleep and Neurology Unit, Beau Soleil Clinic, Montpellier, France
| | - France Woimant
- French National Reference Centre for Wilson's Disease, Foundation Rothschild Hospital, Paris, France; Neurology Department, Lariboisière University Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Aurélia Poujois
- French National Reference Centre for Wilson's Disease, Foundation Rothschild Hospital, Paris, France; Neurology Department, Foundation Rothschild Hospital, Paris, France
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Žigrai M, Vyskočil M, Tóthová A, Vereš P, Bluska P, Valkovič P. Late-Onset Wilson's Disease. Front Med (Lausanne) 2020; 7:26. [PMID: 32118011 PMCID: PMC7016193 DOI: 10.3389/fmed.2020.00026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/16/2020] [Indexed: 01/09/2023] Open
Abstract
Wilson's disease is a rare autosomal recessive disease, caused by impaired secretion of copper into bile due to a defective function of the ATPase 7B enzyme. Clinical manifestation is predominantly hepatic and neurological. Wilson's disease is traditionally considered a disease of children and young adults. It rarely manifests after 40 years of age. In our case report, we present a 67-year-old female in whom Wilson's disease manifested as tremors of the upper extremities and chin that were originally assessed as part of cerebral atherosclerosis and Parkinson's disease. Only the histological finding of liver steatofibrosis, performed due to suspected metastatic changes of the liver, led in the context of neurological symptoms to correct diagnosis and successful treatment.
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Affiliation(s)
- Miroslav Žigrai
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital, Slovak Medical University, Bratislava, Slovakia
| | - Milan Vyskočil
- Department of Internal Medicine, Faculty of Medicine, University Hospital - St. Michael's Hospital, Slovak Medical University, Bratislava, Slovakia
| | - Andrea Tóthová
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital, Slovak Medical University, Bratislava, Slovakia
| | | | | | - Peter Valkovič
- 2nd Department of Neurology, Faculty of Medicine, University Hospital, Comenius University Bratislava, Bratislava, Slovakia
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Cochen De Cock V, Woimant F, Poujois A. Sleep Disorders in Wilson’s Disease. Curr Neurol Neurosci Rep 2019; 19:84. [DOI: 10.1007/s11910-019-1001-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ferenci P, Ott P. Wilson's disease: Fatal when overlooked, curable when diagnosed. J Hepatol 2019; 71:222-224. [PMID: 31126728 DOI: 10.1016/j.jhep.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Peter Ferenci
- Internal Medicine 3, Medical University of Vienna, Vienna, Austria.
| | - Peter Ott
- Department of Clinical Medicine - The Department of Hepatology and Gastroenterology, Aarhus University, Aarhus, Denmark
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Ferreri F, Bourla A, Capron J, Quillerou B, Rossignol J, Borden A, Guechot J, Lamaziere A, Nuss P, Mekinian A, Mouchabac S. [Organic and psychiatric intricacy: The complex psychiatric disorder concept, paraclinical investigations]. Presse Med 2019; 48:609-624. [PMID: 31151849 DOI: 10.1016/j.lpm.2019.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/12/2018] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
The purpose of this article is to describe complex psychiatric disorders, to recall "minimal classical" explorations in psychiatry, to describe the concept of "complex psychiatric disorders" and to propose a systematized method of exploration. Some organic diseases are well known for their links with psychiatric disorders (manic syndrome and hyperthyroidism, depressive syndrome and corticotropic insufficiency, anxiety disorder and heart disease, etc.). Many other neurological, autoimmune, metabolic, paraneoplastic or endocrine pathologies can have essentially psycho-behavioral manifestations before being neurological or systemic. A large number of factors (nutritional, toxic, immunological, etc.), often ignored, influence the links between organicity and psychiatric pathologies. It is necessary to optimize the medical management of these patients in whom the psychiatric diagnosis masks a curable organo-psychiatric cause.
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Affiliation(s)
- Florian Ferreri
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France
| | - Alexis Bourla
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France.
| | - Jean Capron
- Sorbonne université, Paris Univ-06, Paris, hôpital Saint-Antoine, service de neurologie, 75012, Paris, France
| | - Bluenn Quillerou
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France
| | - Julien Rossignol
- Université Paris 5, hôpital Necker Enfant Malades, service hématologie, 75015 Paris, France
| | - Alaina Borden
- Sorbonne université, Paris Univ-06, Paris, hôpital Saint-Antoine, service de neurologie, 75012, Paris, France
| | - Jérome Guechot
- Sorbonne université, Paris Univ-06, Paris, laboratoire d'hormonologie et immunoanalyse, HUEP, site Saint-Antoine, 75012, Paris, France
| | - Antonin Lamaziere
- Sorbonne université, Paris Univ-06, Paris, laboratoire d'hormonologie et immunoanalyse, HUEP, site Saint-Antoine, 75012, Paris, France; CHU Saint-Antoine, Inserm ERL 1157, 75012 Paris, France; Sorbonne universités-UPMC université Paris 06, UMR 7203, laboratoire des biomolécules, 75005 Paris, France
| | - Philippe Nuss
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France; CHU Saint-Antoine, Inserm ERL 1157, 75012 Paris, France; Sorbonne universités-UPMC université Paris 06, UMR 7203, laboratoire des biomolécules, 75005 Paris, France
| | - Arsène Mekinian
- Sorbonne université, Paris Univ-06, Paris, hôpital Saint-Antoine, service de médecine interne, 75012, Paris, France
| | - Stéphane Mouchabac
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France
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Ferenci P, Stremmel W, Członkowska A, Szalay F, Viveiros A, Stättermayer AF, Bruha R, Houwen R, Pop TL, Stauber R, Gschwantler M, Pfeiffenberger J, Yurdaydin C, Aigner E, Steindl-Munda P, Dienes HP, Zoller H, Weiss KH. Age and Sex but Not ATP7B Genotype Effectively Influence the Clinical Phenotype of Wilson Disease. Hepatology 2019; 69:1464-1476. [PMID: 30232804 DOI: 10.1002/hep.30280] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/12/2018] [Indexed: 02/05/2023]
Abstract
Wilson disease (WD) is an inherited disorder of hepatic copper metabolism with considerable variation in clinical presentations, the most common ones being liver disease and neuropsychiatric disturbances. This study investigated the clinical presentation in relation to mutations in a large cohort of patients with WD. A total of 1,357 patients (702 children, 655 adults; 1,172 index patients, 185 siblings, all with a Leipzig score ≥4, male/female: 679/678) were studied. The age and the symptoms at presentation were used as key phenotypic markers. Index patients were clinically classified as having either hepatic (n = 711) or neurologic disease (n = 461). Seven hundred fifteen (52.7%) patients had a liver biopsy at diagnosis. DNA was sequenced by the Genetic Analyzers ABI Prism 310 (Perkin Elmer) or 3500 (Applied Biosystems). Three hundred ninety-four different mutation combinations were detected. The most frequent mutation was H1069Q (c.3207C>A; allele frequency: 46.9%), followed by P767P-fs (c.2304dupC; 2.85%), P1134P-fs (c.3402delC; 2.8%), and R969Q (c.2755C>T; 2.18%). There was no correlation between mutations and individual clinical manifestation. There was a gender effect in index patients: Hepatic presentation was more common in females (male/female: 328/383) and neurologic presentation in males (259/202; P < 0.001). At diagnosis, 39.5% of children/adolescents (≤18 years) and 58% of adults already had cirrhosis. The presence of cirrhosis did not correlate with the genotype. Conclusion: These findings refine and extend our understanding of the natural history and individual spectrum/manifestations of WD. Initially, there is asymptomatic hepatic involvement, which may progress and become symptomatic. Neurologic symptoms present many years later.
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Affiliation(s)
- Peter Ferenci
- Department of Internal Medicine III, Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Stremmel
- Department of Internal Medicine IV, Medical University of Heidelberg, Heidelberg, Germany
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, and Department of Pharmacology, Medical University of Warsaw, Poland
| | - Ferenc Szalay
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - André Viveiros
- First Department of Internal Medicine, Medical University Innsbruck, Austria
| | | | - Radan Bruha
- Fourth Medical Department, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roderick Houwen
- Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
| | - Tudor Lucian Pop
- Second Pediatric Clinic, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania
| | - Rudolf Stauber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Jan Pfeiffenberger
- Department of Internal Medicine IV, Medical University of Heidelberg, Heidelberg, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology and Hepatology, Ankara University Medical School, Ankara, Turkey
| | - Elmar Aigner
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Petra Steindl-Munda
- Department of Internal Medicine III, Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Hans-Peter Dienes
- Department of Clinical Pathology, Medical University of Vienna, Austria
| | - Heinz Zoller
- First Department of Internal Medicine, Medical University Innsbruck, Austria
| | - Karl Heinz Weiss
- Department of Internal Medicine IV, Medical University of Heidelberg, Heidelberg, Germany
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Stremmel W, Merle U, Weiskirchen R. Clinical features of Wilson disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S61. [PMID: 31179298 PMCID: PMC6531660 DOI: 10.21037/atm.2019.01.20] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/07/2019] [Indexed: 11/06/2022]
Abstract
Wilson disease (WD) presents often as a chameleon with a plethora of mild and discrete symptoms. As disease of young aged people, the clinical diagnosis is extremely difficult and misdiagnoses are frequent. Tremor, dysarthria and hepatomegaly sometimes suggest alcoholic liver disease which is a disaster for the patients. Due to the only moderate abnormality of liver function tests the disease is underestimated in its severity with a fatal prognosis when not adequately treated. Therefore, it is the challenge to consider WD as diagnosis, particularly in young patients with unclear liver disease, neuropsychiatric disorders or hemolysis.
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Affiliation(s)
- Wolfgang Stremmel
- Institute of Pharmacy and Molecular Biotechnology, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology and Hepatology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH-University Hospital, Aachen, Germany
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15
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Poujois A, Woimant F. Challenges in the diagnosis of Wilson disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S67. [PMID: 31179304 PMCID: PMC6531657 DOI: 10.21037/atm.2019.02.10] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/31/2019] [Indexed: 01/17/2023]
Abstract
The understanding and management of Wilson disease (WD) have dramatically improved since the first description of the disease by K. Wilson more than a century ago. However, the persistent long delay between the first symptoms and diagnosis emphasizes challenges in diagnosing earlier this copper overload disorder. As a treatable disease, WD should be detected early in the course of the disease by any health professionals at any care level, but the rare prevalence of the disease explains the lack of awareness of referring physicians. The most important challenge is to train physicians to recognize atypical or rare symptoms of WD that will lead to discuss the diagnosis more systematically. Atypia can come from the age of onset, the liver [non-alcoholic steatohepatitis (NASH) presentation], the central or peripheral nervous system (neuropathy, epilepsy, sleep disorders…) or may be due to lesions of other organs (renal manifestations, osteo-articular disorders or endocrine disturbances). Isolated biological anomalies, rare radiological findings or inadequate interpretation of copper test may also lead to misdiagnosis. The second challenge is to confirm the diagnosis faster and more effectively so as not to delay the initiation of treatment, and expand family screening as the genetic prevalence is higher than previously expected. Generalization of the exchangeable copper assay and the next generation sequencing (NGS) are two promising ways to overcome this ultimate challenge. By drawing attention to the earliest and rare symptoms and to new biomarkers and diagnostic tools, we hope that this article will increase diagnostic awareness and reduce delays so that patients can start their treatment earlier in the course of the illness and thus have a better disease prognosis.
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Affiliation(s)
- Aurélia Poujois
- Neurology Department, AP-HP, Lariboisière University Hospital, Paris, France
- National Reference Centre for Wilson Disease, AP-HP, Lariboisière University Hospital, Paris, France
| | - France Woimant
- Neurology Department, AP-HP, Lariboisière University Hospital, Paris, France
- National Reference Centre for Wilson Disease, AP-HP, Lariboisière University Hospital, Paris, France
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