title: MRI and oxidative stress markers in neurological worsening of Wilson disease following penicillamine.
abstract: OBJECTIVE
  There is no report of MRI correlation with neurological worsening following chelating treatment in Wilson disease with neurological manifestation (WDN). We report radiological changes in four patients with WDN who worsen after penicillamine.
  
  
  METHODS
  WDN was diagnosed on the basis of clinical, KF ring, serum ceruloplasmin and 24h urinary copper. Hematological, biochemical and cranial MRI were repeated at the time of clinical deterioration following chelating treatment.
  
  
  RESULTS
  Four WDN patients had neurological deterioration within 4-8 weeks of penicillamine therapy. This was associated with new lesions in white matter, thalamus, pons and mid brain and these lesions showed diffusion restriction. The neurologic deterioration was associated with increased free serum copper and malanodialdehyde and reduced glutathione. Clinical conditions stabilized after few weeks of penicillamine discontinuation.
  
  
  CONCLUSIONS
  Neurological worsening was associated with new lesions on MRI which revealed diffusion restriction. Increased free copper induced oxidative stress may be responsible for these changes.
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: A
authors.initials: A
authors.lastname: Ranjan
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. Electronic address: jayanteek@yahoo.com.
authors.forename: J
authors.initials: J
authors.lastname: Kalita
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: V
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: U K
authors.initials: UK
authors.lastname: Misra
mesh_terms: D000328:Adult; D000931:Antidotes / Q000009:adverse effects*; D002648:Child; D006527:Hepatolenticular Degeneration / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000209:etiology / Q000473:pathology*; D018384:Oxidative Stress / Q000187:drug effects*; D010396:Penicillamine / Q000009:adverse effects*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000931:Antidotes; D010396:Penicillamine
keywords: MRI; Penicillamine; Trientine; Wilson disease; Worsening