Prashanth et al evaluated patients with severe neurologic findings associated with Wilson's disease. Certain prognostic factors can distinguish patients with progressive disease from those with a better prognosis. The authors are from that National Institute of Mental Health and Neurosciences in Bangalore, India.
Patient selection: Wilson's disease with severe neurological findings
Factor
Worse Prognosis
Better Prognosis
diagnosis
late
early
compliance with chelation therapy
poor
good
penicillamine therapy
aggressive with high initial dose
low initial dose with gradual increases
white matter changes on MRI
extensive and diffuse
less extensive
changes in MRI with therapy
no change or progression
regression of lesions
clinical changes with therapy
no change or progression
clinical improvement
A patient with a worse prognosis may have progressive neurologic disease with death.
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