Brain volume is related to neurological impairment and to copper overload in Wilson’s disease

INTRODUCTION: To determine whether brain volume was associated with functional and neurological impairments and with copper overload markers in patients with Wilson’s disease. METHODS: In 48 treatment-naïve patients, we assessed functional and neurological impairments with the Unified Wilson’s Disease Rating Scale, measured normalized brain volumes based on magnetic resonance images, and assessed concentration of non-ceruloplasmin-bound copper. We correlated brain volume measures with functional and neurological impairment scores and copper overload indices. RESULTS: Functional and neurological impairments correlated with all brain volume measures, including the total brain volume and the volumes of white matter and gray matter (both peripheral gray matter and deep brain nuclei). Higher non-ceruloplasmin-bound copper concentrations were associated with greater functional and neurological impairments and lower brain volumes. CONCLUSIONS: Our findings provided the first in vivo evidence that the severity of brain atrophy is a correlate of functional and neurological impairments in patients with Wilson’s disease and that brain volume could serve as a marker of neurodegeneration induced by copper. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10072-019-03942-z) contains supplementary material, which is available to authorized users.