Diagnosis and Outcomes of Late‐Onset Wilson's Disease: A National Registry‐Based Study

• Published in: Movement disorders 2023-02, Vol.38 (2), p.321-332
• Main Authors: Nilles, Christelle, Obadia, Mickael Alexandre, Sobesky, Rodolphe, Dumortier, Jérôme, Guillaud, Olivier, Laurencin, Chloé, Moreau, Caroline, Vanlemmens, Claire, Ory‐Magne, Fabienne, Ledinghen, Victor, Bardou‐Jacquet, Edouard, Fluchère, Frederique, Collet, Corinne, Oussedik‐Djebrani, Nouzha, Woimant, France, Poujois, Aurélia
• Format: Article
• Language: English
• Subjects: Adult; Age; Ceruloplasmin - metabolism; Ceruloplasmin - therapeutic use; Child; Cirrhosis; Copper; Copper - metabolism; Copper - therapeutic use; Delayed Diagnosis; Diagnosis; Disease management; exchangeable copper; Hepatolenticular Degeneration - diagnosis; Humans; late onset; Life Sciences; Liver transplantation; Magnetic resonance imaging; Medical diagnosis; Middle Aged; Movement disorders; Neuroimaging; Patients; registry; relative exchangeable copper; Torticollis; Wilson's disease; Young Adult; Young adults
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.29292

Background Wilson's disease (WD) is usually diagnosed in children and young adults; limited data exist on late‐onset forms. Objective The aim was to characterize the clinical and paraclinical presentations, therapeutic management, and outcomes in patients with late‐onset WD. Methods Patients diagnosed with WD after age 40 years were identified from the French Wilson's Disease Registry (FWDR). Clinical, laboratory, and imaging findings and treatment were reported at diagnosis and last follow‐up. Results Forty‐five patients were identified (median age: 49, range: 40–64) and placed in three groups according to their clinical presentation: neurological (n = 20, median diagnostic delay: 20 months), hepatic (n = 13, diagnostic delay: 12 months), and family screening (n = 12), all confirmed genetically. Six neurological patients had an atypical presentation (1 torticollis, 2 writer's cramps, 2 functional movement disorders, and 1 isolated dysarthria), without T2/fluid‐attenuated inversion recovery brain magnetic resonance imaging (MRI) hyperintensities; 5 of 6 had no Kayser–Fleischer ring (KFR); 5 of 6 had liver involvement. In the neurological group, 84% of patients improved clinically, and 1 developed copper deficiency. In the hepatic group, 77% had cirrhosis; 6 patients required liver transplantation. In the screened group, 43% had mild liver involvement; 3 were not treated and remained stable; 24‐h urinary copper excretion was normal in 33% of patients at diagnosis. Conclusions In the FWDR, late‐onset forms of WD affect 8% of patients, mostly with neurological presentations. Thirty percent of the neurological forms were atypical (isolated long‐lasting symptoms, inconspicuous brain MRI, no KFR). With personalized treatment, prognosis was good. This study emphasized that WD should be suspected at any age and even in cases of atypical presentation. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.