Atypical Presentation of Neuropsychiatric Variant of Wilson’s Disease and Clinical Improvement with Elemental Zinc Monotherapy

Authors

  • Simranjit Kaur Varun Arjun Medical College and Rohilkhand Hospital
  • Utkarsh Kumar Tripathi Varun Arjun Medical College and Rohilkhand Hospital
  • Abhishek Chakladar Varun Arjun Medical College and Rohilkhand Hospital
  • Zaid Ahmed Varun Arjun Medical College and Rohilkhand Hospital
  • Gaurav Verma Varun Arjun Medical College and Rohilkhand Hospital
  • Alexander Martin Alphonse Varun Arjun Medical College and Rohilkhand Hospital
  • Ankan Paul Varun Arjun Medical College and Rohilkhand Hospital

DOI:

https://doi.org/10.54169/ijocp.v3i02.81

DOI:

Keywords:

Wilson's disease, zinc, monotherapy, extrapyramidal symptoms, copper

Abstract

Wilson’s disease has been referred to as “the great masquerader” because it has a plethora of clinical manifestations based on the organ system involved.1 Current understanding is that neuropsychiatric WD develops after years of subclinical hepatic dysfunction.1 Neurologic dysfunction typically begins at approximately 20 years of age but can present earlier or later.2 In WD, the predominant neurologic manifestations (60%) are dysarthria, tremor and ataxia, followed by dystonia (15%) and parkinsonism (11%).3,4 In WD, pure psychiatric presentations are typically seen in patients in their teens. However, symptoms are often non-specific and frequently misdiagnosed as behavioral problems.5 Therefore, in many cases, when the clinical suspicion is low, the diagnosis of Wilson’s disease is often delayed or missed.

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Author Biographies

Simranjit Kaur, Varun Arjun Medical College and Rohilkhand Hospital

Junior Resident, Department of Psychiatry, Varun Arjun Medical College and Rohilkhand Hospital

Utkarsh Kumar Tripathi, Varun Arjun Medical College and Rohilkhand Hospital

Junior Resident, Department of Psychiatry, Varun Arjun Medical College and Rohilkhand Hospital

Abhishek Chakladar, Varun Arjun Medical College and Rohilkhand Hospital

Assistant Professor, Department of Psychiatry, Varun Arjun Medical College and Rohilkhand Hospital

Zaid Ahmed, Varun Arjun Medical College and Rohilkhand Hospital

Assistant Professor, Department of Psychiatry, Varun Arjun Medical College and Rohilkhand Hospital

Gaurav Verma, Varun Arjun Medical College and Rohilkhand Hospital

Associate Professor, Department of Psychiatry, Varun Arjun Medical College and Rohilkhand Hospital

Alexander Martin Alphonse, Varun Arjun Medical College and Rohilkhand Hospital

Professor and Head of the Department of Psychiatry, Varun Arjun Medical College and Rohilkhand Hospital

Ankan Paul, Varun Arjun Medical College and Rohilkhand Hospital

Senior Resident, Department of Psychiatry, Varun Arjun Medical College and Rohilkhand Hospital

References

Sean Cleymaet, Katsuko Nagayoshi, Edward Gettings & Justin Faden (2019): A review and update on the diagnosis and treatment of neuropsychiatric Wilson disease, Expert Review of Neurotherapeutics, DOI: 10.1080/14737175.2019.1645009

Merle U, Schaefer M, Ferenci P, et al. Clinical presentation, diagnosis and long-term outcome of Wilson’s disease: a cohort study. Gut. 2007; 56:115– 120.

Członkowska A, Litwin T, Dzieżyc K, et al. Characteristics of a newly diagnosed Polish cohort of patients with neurological manifestations of Wilson disease evaluated with the Unified Wilson’s Disease Rating Scale. BMC Neurol. 2018; 18:34.

Hedera P. Wilson’s disease: A master of disguise. Parkinsonism Relat. Disord. 2019.

Carta M, Mura G, Sorbello O, et al. Quality of Life and Psychiatric Symptoms in Wilson’s Disease: the Relevance of Bipolar Disorders. Clin. Pract. Epidemiol. Ment. Health. 2012; 8:102–109.

Sinha S, Taly AB, Ravishankar S, et al. Wilson’s disease: cranial MRI observations and clinical correlation. Neuroradiology. 2006; 48:613–621.

Roberts EA, Schilsky ML. Diagnosis and treatment of Wilson disease: An update. Hepatology. 2008; 47:2089–2111.

Brewer GJ, Dick RD, Johnson VD, et al. Treatment of Wilson’s disease with zinc: XV long-term follow-up studies. J. Lab. Clin. Med. 1998; 132:264– 278.

Linn FHH, Houwen RHJ, van Hattum J, et al. Long-term exclusive zinc monotherapy in symptomatic Wilson disease: Experience in 17 patients. Hepatology. 2009;50:1442–1452

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Published

2023-11-08

How to Cite

Kaur, S., Kumar Tripathi, U., Chakladar, A., Ahmed, Z., Verma, G., Martin Alphonse, A., & Paul, A. (2023). Atypical Presentation of Neuropsychiatric Variant of Wilson’s Disease and Clinical Improvement with Elemental Zinc Monotherapy. Indian Journal of Clinical Psychiatry, 3(02). https://doi.org/10.54169/ijocp.v3i02.81