title: Small fiber dysfunction in patients with Wilson's disease.
abstract: OBJECTIVE
  Patients with Wilson's disease (WD) may develop a wide variety of neuropsychiatric symptoms, but there are few reports of autonomic dysfunction. Here, we described evidence of small fiber and/or autonomic dysfunction in 4 patients with WD and levodopa-responsive parkinsonism.
  
  
  METHODS
  We reviewed the charts of 4 patients with WD who underwent evaluation for the presence of neuromuscular dysfunction and water-induced skin wrinkling test (SWT).
  
  
  RESULTS
  Two men and 2 women (33±3.5 years) with WD were evaluated. They all had parkinsonism at some point during their disease course. Parkinsonism on patient 4 almost completely subsided with treatment of WD. Two patients had significant sensory and 2 significant autonomic complaints, including syncopal spells. NCS/EMG was normal in all but SWT was abnormal in half of them (mean 4-digit wrinkling of 0.25 and 1).
  
  
  CONCLUSIONS
  A subset of patients with WD exhibit evidence of abnormal skin wrinkling test (small fiber neuropathy).
authors.affiliation: Departamento de Medicina Clínica, Serviço de Neurologia, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
authors.forename: Francisco de Assis A
authors.initials: Fde A
authors.lastname: Gondim
authors.affiliation: Universidade Federal do Ceará, Fortaleza, CE, Brazil.
authors.forename: Davi F
authors.initials: DF
authors.lastname: Araújo
authors.affiliation: Universidade Federal do Ceará, Fortaleza, CE, Brazil.
authors.forename: Italo S
authors.initials: IS
authors.lastname: Oliveira
authors.affiliation: Departamento de Medicina Clínica, Serviço de Neurologia, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
authors.forename: Otoni Cardoso do
authors.initials: OC
authors.lastname: Vale
mesh_terms: D000328:Adult; D004576:Electromyography; D005260:Female; D006527:Hepatolenticular Degeneration / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009412:Nerve Fibers / Q000502:physiology*; D009431:Neural Conduction / Q000502:physiology*; D010525:Peripheral Nerves / Q000503:physiopathology*; D055815:Young Adult