Wilson disease (WD) is a rare inherited disorder of copper metabolism in which excessive amounts of copper accumulate in the body.  The buildup of copper leads to damage in the liver, brain, and eyes.  Although copper accumulation begins at birth, symptoms of the disorder only appear later in life.  The most characteristic sign of WD is the Kayser-Fleisher ring – a rusty brown ring around the cornea of the eye that can best be viewed using an ophthalmologist’s slit lamp. The primary consequence for most individuals with WD is liver disease, appearing in late childhood or early adolescence as acute hepatitis, liver failure, or progressive chronic liver disease in the form of chronic active hepatitis or cirrhosis of the liver.  In others, the first symptoms are neurological, occur later in adulthood, and commonly include slurred speech (dysarthria), difficulty swallowing (dysphagia), and drooling.  Other symptoms may include tremor of the head, arms, or legs; impaired muscle tone, and sustained muscle contractions that produce abnormal postures, twisting, and repetitive movements (dystonia); and slowness of movements (bradykinesia).  Individuals may also experience clumsiness (ataxia) and loss of fine motor skills.  One-third of individuals with WD will also experience psychiatric symptoms such as an abrupt personality change, bizarre and inappropriate behavior, depression accompanied by suicidal thoughts, neurosis, or psychosis.  WD is diagnosed with tests that measure the amount of copper in the blood, urine, and liver.  WD requires lifelong treatment, generally using drugs that remove excess copper from the body and prevent it from re-accumulating.  Zinc, which blocks the absorption of copper in the stomach and causes no serious side effects, is often considered the treatment of choice. Penicillamine and trientine are copper chelators that increase urinary excretion of copper; however, both drugs have some side effects.  Tetrathiomolybdate is an investigational copper chelating drug with a lower toxicity profile, but it has not been approved by the Food and Drug Administration for the treatment of WD and its long-term safety and effectiveness aren’t known.  A low-copper diet is also recommended, which involves avoiding mushrooms, nuts, chocolate, dried fruit, liver, and shellfish.  In rare cases where there is severe liver disease, a liver transplant may be needed.  Symptomatic treatment for symptoms of muscle spasm, stiffness, and tremor may include anticholinergics, tizanidine, baclofen, levodopa, or clonazepam.  Early onset of the disease may foretell a worse prognosis than later onset.  If the disorder is detected early and treated appropriately, an individual with WD can usually enjoy normal health and a normal lifespan.  If not treated, however, WD can cause brain damage, liver failure, and death.  The disease requires lifelong treatment.  The National Institute of Neurological Disorders and Stroke, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and other institutes of the National Institutes of Health (NIH) conduct and/or support research related to Wilson disease.  Growing knowledge of the copper transporting gene ATP7B, which in its mutated form causes WD, should lead to the design of better therapies for this disorder.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&term=hepatolenticular+degeneration+AND+human[mh]+AND+english[la]+AND+(review[ptyp]+OR+review+literature[mh]+OR+practice+guideline[ptyp]+OR+guideline[ptyp]+OR+clinical+trials[mh]+OR+clinical+trial[ptyp]+OR+consumerj[sb])&db=PubMed&orig_db=PubMed&filters=on&pmfilter_EDatLimit=5+Years http://www.nlm.nih.gov/medlineplus/wilsondisease.html 1 http://clinicaltrials.gov/ct2/results?term= /disorders/wilsons/pubs_wilsons.htm /disorders/wilsons/xml_wilsons.xml xml_wilsons.xml V628 American Liver Foundation

39 Broadway, Suite 2700

New York NY 10006 info@liverfoundation.org http://www.liverfoundation.org 800-GO LIVER (465-4837) 212-668-1000 212-483-8179 National non-profit health agency dedicated to the prevention, treatment, and cure of hepatitis and all liver diseases through research, education, and advocacy. V41 March of Dimes

1275 Mamaroneck Avenue

White Plains NY 10605 askus@marchofdimes.com http://www.marchofdimes.com 914-997-4488 888-MODIMES (663-4637) 914-428-8203 Works to improve the health of babies by preventing birth defects and infant mortality through programs of research, community services, education, and advocacy. V629 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

National Institutes of Health, DHHS

31 Center Drive, Rm. 9A06 MSC 2560 Bethesda MD 20892-2560 http://www.niddk.nih.gov 301-496-3583 TTY: 866-569-1162 V252 Wilson Disease Association

5572 N. Diversey Blvd.

Milwaukee MI 53217 info@wilsonsdisease.org http://www.wilsonsdisease.org 414-961-0533 866-961-0533 414-962-3886 All-volunteer organization that strives to promote the well-being of patients with Wilson Disease and their families and friends. V85 WE MOVE (Worldwide Education & Awareness for Movement Disorders)

5731 Mosholu Avenue

Bronx NY 10024 wemove@wemove.org http://www.wemove.org 347-843-6132 718-601-5112 WE MOVE provides movement disorder information and educational materials to physicians, patients, the media, and the public.