Optical coherence tomography as a marker of neurodegeneration in patients with Wilson\u2019s disease

Ewa Langwińska-Wośko,Anna Członkowska,Karolina Dzieżyc,Michał Karlinski,Tomasz Litwin

doi:10.1007/s13760-017-0788-5

Ewa Langwińska-Wośko, Anna Członkowska + Show 3 more

Open Access

https://doi.org/10.1007/s13760-017-0788-5

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Abstract

Wilson’s disease (WD) is an inherited autosomal recessive disorder that leads to pathological copper accumulation in different organs. Optical coherence tomography (OCT) is proposed as a marker of neurodegeneration in many neurological diseases. Thinning of the total retinal nerve fiber layer (RNFL) and macular thickness (Mth) examined by OCT was detected in patients with WD, especially those with brain magnetic resonance imaging changes. The aim of this study was to evaluate the relationship between OCT parameters and the progression of neurological signs measured by the Unified Wilson’s Disease Rating Scale (UWDRS) in patients with WD. Consecutive patients with WD admitted to the Department of Neurology underwent OCT to assess the thickness of the macula and total RNFL. Patients also had neurologic assessments according to the UWDRS part III. Patients were divided into two groups based on the presence (UWDRS+) and absence (UWDRS−) of neurological symptoms. Fifty-eight patients (34 females, 24 males) were enrolled. Mean duration of treatment was 9 years (standard deviation [SD], ±10.8). The mean UWDRS score at the time of study was 8.4 (range 1–52; SD ±13.9) points. Total RNFL as well as macula thickness were significantly decreased in the UWDRS+ group versus the UWDRS− group. A significant negative correlation was found between OCT parameters (RNFL and Mth measurements) and neurological impairment according the UWDRS scale. This study confirms that OCT may be a useful tool for measuring the degree of neurodegeneration in patients with WD, and may play role in monitoring disease progression.

Highlights

Wilson’s disease (WD) is an inherited autosomal recessive disorder that leads to copper accumulation in the liver, brain, cornea, and other organs
The aim of this study was to evaluate the relationship between Optical coherence tomography (OCT) parameters and the progression of neurological signs measured by the Unified Wilson’s Disease Rating Scale (UWDRS) in patients with WD
A significant negative correlation was found between OCT parameters (RNFL and macular thickness (Mth) measurements) and neurological impairment according the UWDRS scale

Summary

Introduction

Wilson’s disease (WD) is an inherited autosomal recessive disorder that leads to copper accumulation in the liver, brain, cornea, and other organs. The most common ophthalmological sign is the Kayser–Fleischer ring as a result of accumulation of copper in the cornea [1, 2]. Sunflower cataract is a rare ophthalmological manifestation of patients with WD that is sometimes observed during the course of the disease [3]. OCT is a non-invasive imaging technique that provides objective assessments of the retinal nerve fiber layer (RNFL), which is mainly composed of unmyelinated axons [6, 7]. Measuring the thickness of the RNFL with OCT provides an objective estimate of the integrity of these axons. Thinning of the RNFL as a result of axonal loss was previously proposed to be a marker of neurodegeneration in many diseases including WD [8,9,10]

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