The asymmetry of neural symptoms in Wilson's disease patients detecting by diffusion tensor imaging, resting‐state functional MRI, and susceptibility‐weighted imaging

Abstract

ObjectiveTo investigate the cause of the motor asymmetry in Wilson's disease (WD) patients using functional MRI.MethodsFifty patients with WD and 20 age‐matched healthy controls were enrolled. Neurological symptoms were scored using the modified Young Scale. All study subjects underwent diffusion tensor imaging (DTI), susceptibility‐weighted imaging (SWI), and resting‐state functional MRI (rs‐fMRI) of the brain. Six regions of interest (ROI) were chosen. Fiber volumes between ROIs on DTI, corrected phase (CP) values on SWI, amplitude of low‐frequency fluctuation (ALFF), and regional homogeneity (REHO) values on rs‐fMRI were determined. Asymmetry index (right or left value/left or right value) was evaluated.ResultsAsymmetry of rigidity, tremor, choreic movement, and gait abnormality (asymmetry index = 1.33, 1.39, 1.36, 1.40), fiber tracts between the GP and substantia nigra (SN), GP and PU, SN and thalamus (TH), SN and cerebellum, head of the caudate nucleus (CA) and SN, PU and CA, CA and TH, TH and cerebellum (asymmetry index = 1.233, 1.260, 1.269, 1.437, 1.503, 1.138, 1.145, 1.279), CP values in the TH, SN (asymmetry index = 1.327, 1.166), ALFF values, and REHO values of the TH (asymmetry index = 1.192, 1.233) were found. Positive correlation between asymmetry index of rigidity and fiber volumes between the GP and SN, SN and TH (r = .221, .133, p = .043, .036), and tremor and fiber volumes between the CA and TH (r = .045, p = .040) was found.ConclusionsThe neurological symptoms of patients with WD were asymmetry. The asymmetry of fiber projections may be the main cause of motor asymmetry in patients with WD.

Clinical presentations of Wilson disease

“…This can mimic essential tremor, a much more prevalent movement disorder that also occurs in young people. Tremor in WD, like dystonia and parkinsonism, can also be asymmetrical (72). Wing-beating tremor refers to a large amplitude postural tremor in the upper limbs that emerges as the elbows are flexed.…”

An Updated Overview of the Magnetic Resonance Imaging of Brain Iron in Movement Disorders

“…Whenever neurologic disorders occur in patients, copper and iron contents are higher than those in patients with only hepatic symptoms [ 118 ]. No correlation has been reported between the asymmetry of CP values in the subcortical nuclei and the motor asymmetry [ 125 ]. Furthermore, a negative correlation has been reported between SWI phase values of GP and the severity of dysarthria, while a negative correlation has been detected between SWI phase values of CN and the extent of tremor [ 120 ] ( Table 1 ).…”

Neurological Type Wilson’s Disease: Epidemiology, Clinical Manifestations, Diagnosis, and Management

“…In all eight patients, there was damage seen in the caudate nucleus [21]. Another study in 2018 found that patients with choreic movement had marked asymmetry of the ber volumes between the caudate nucleus and the thalamus [22]. The treatment of choreoathetosis is limited to dopamine depletion agents such as tetrabenazine and behavioral therapy.…”

“…Like many other neurodegenerative diseases, the tremor can be unilateral or bilateral. A study in 2018 analyzing the tremor of WD found that tremor asymmetry was in uenced by the asymmetry of ber volumes between the thalamus and cerebellum as well as the caudate nucleus and the thalamus [22].…”