Wilson’s disease is a rare, inherited condition in which the body cannot handle copper correctly. This leads to a toxic build-up of copper in the liver and brain.
It is estimated that around one in 30,000 people has Wilson’s disease. It is more common in some areas, for example, Sardinia and some Eastern European countries.
In younger children it is often the liver which is most affected. In teenagers and adults the brain may be more affected. Between half and two-thirds of Wilson’s disease patients show symptoms before the age of 15 and most of these will have liver disease.
Why does the body contain copper?
Copper is needed to survive and is found in many foods as well as in drinking water. Not having enough copper can cause a reduction in the number of red blood cells in the blood (anaemia) and poor growth.
Each day we take in approximately 1mg of copper. Foods which contain a lot of copper include liver and shellfish. Other offal, nuts and seeds contain copper but less than liver and shellfish. Large intakes of dark chocolate may also increase copper intake but not as much as the other foods listed.
What causes Wilson’s disease?
Wilson’s disease has a genetic basis which means it is caused by changes in genes which make up our DNA. The gene affected in Wilson’s disease is called ATP7B.
Wilson’s disease is “autosomal recessive”. This means that, in order to develop Wilson’s disease, a person must have two Wilson’s disease genes, one inherited from each parent.
If the parents of a child with Wilson’s disease do not have the disease, they will be carriers for the gene but will not be unwell because of it.
There are over 500 different genetic mutations which can cause Wilson’s disease. People from different parts of the world have different mutations.
The gene involved in Wilson’s disease is one which instructs liver cells to make a protein which acts as a “copper pump”. This copper pump transports copper out of the liver cells into bile. When an individual has two faulty copies of the gene the copper pump isn’t formed properly so can’t pump the copper out into the bile.
If two parents have a child with Wilson’s disease, but they don’t have the condition themselves, the chance of any children they have in the future of having Wilson’s disease is 25% (one out of every four children).
What are the signs and symptoms of Wilson’s disease?
Wilson’s disease can have a number of different effects within the liver. In mild cases the symptoms may include:
- Loss of appetite
- Abdominal pain
- Joint pain
- Weight loss
- Nose bleeds
There may be symptoms of chronic (ongoing) liver disease such as:
- A large spleen
- Dilated blood vessels in the stomach and oesophagus (varices)
Some children and young people may have acute liver failure.
Patients may have been diagnosed because other members of the family are known to have Wilson’s disease.
How can the brain be affected by Wilson’s disease?
The effect on the brain is more common in teenagers or adults. There may, however, be a small change in learning ability in children.
A range of problems may occur and can include:
- Declining school or college performance
- Changes in behaviour or personality
- Deterioration of motor skills such as handwriting or balance
As the disease progresses, and without treatment, there may be tremors, rigidity, and further loss of motor skills.
In more serious cases, a child’s mood and personality may change for a short period of time. This can cause children to behave in a way that is different to usual. They may swear, shout and become aggressive. This can be difficult for parents to see but is a temporary change due to the build-up of copper in the brain.
How is Wilson’s disease diagnosed?
Wilson’s disease may be considered in any child over three years of age who has acute or chronic liver disease.
If it is suspected that a child or a young person may have Wilson’s disease then there are a number of tests which can be used to confirm the diagnosis.
Blood is taken to carry out liver function tests . Copper levels will also be tested. Often blood tests will show that children with Wilson’s disease are anaemic. DNA will be sent for testing of the ATP7B gene.
In Wilson’s disease the copper levels in urine are high. The levels of copper are measured in two 24 hour urine collections before and after a test dose of medication is given.
The amount of copper in the liver can be measured from a biopsy sample. A biopsy may also show typical chronic liver disease changes and excess copper. Find out more about liver biopsies.
An MRI (magnetic resonance imaging) scan may show a build-up of copper in the areas of the brain which are often affected.
Copper accumulation in the eye may cause a golden-brown ring to form around the edge of the iris, called a Kayser-Fleischer ring. This ring is only visible using a special instrument (a slit-lamp and is rarely seen before the age of 10 years.
Can Wilson’s disease be treated?
The treatment of Wilson’s disease depends on how severe the liver disease is.
Acute liver failure (sudden damage to the liver) may require an urgent liver transplant.
Chronic liver disease (damage to the liver over a period of time) can be treated using a number of different medications which help to remove the build-up of excess copper.
Treatment should start as soon as an individual is diagnosed with Wilson’s disease as this can stop further damage happening. It is really important that once an individual is diagnosed they continue to take their medication, even if they feel well. It can take a number of months to begin to feel back to normal and for blood tests to improve. It can take weeks or months before a young person is ready to return to normal activities, such as going to school.
The long term outcomes for patients who take their prescribed medications properly are excellent. If patients don’t take their medications properly or stop taking their medication then they can become very unwell.
Individuals who are found to have Wilson’s disease when they are tested because a sibling has been diagnosed generally respond very well to treatment. This stops symptoms developing if medication is continued correctly. For those who already have symptoms the possibility and success of treatment will depend on the degree of damage the liver already has. A number of blood tests and scans can be done to see how badly the liver is already damaged.
Sometimes patients will require treatment for the complications of liver disease, such as portal hypertension and ascites (abdominal swelling), as well as a nutritional assessment.
For those with end stage liver disease liver transplantation is a possibility and the outcomes are generally very positive. Find out more about liver transplant.
What medicines are available?
How long does treatment continue for?
Treatment is needed for life. The effectiveness and side effects of treatment will be monitored by regular hospital follow-up visits. This will include blood and urine tests. If taken the right way all the time, the treatment is very effective. If doses are missed regularly or treatment is stopped for a period of time, the liver and/or brain may be permanently damaged before any problems are noticed.
Are there any restrictions on lifestyle?
For those who are well at the time the disease is diagnosed there are no lifestyle restrictions.
Liver and/or damage to the brain (neurological damage) which has already happened will need to be discussed by your doctor regarding potential complications. The non-specific signs such as lethargy (extreme tiredness), abdominal pain and nausea will settle but may take some weeks or even months to do so.
During this time physical activity, schooling and work may need to be reduced and then gradually increased back to normal as symptoms stop. If you have any queries about this, talk to your medical team who will be able to discuss the best plan for your child with you.
When is a liver transplant necessary?
Not all patients who are diagnosed with Wilson’s disease will need a liver transplant. There are four reasons why liver transplantation may be necessary:
- Acute liver failure
- Failure of medication to stop the progression of the liver damage
- Complications of liver damage which occurred before treatment started
- Liver damage which occurred because medication was not taken
Does a liver transplant cure Wilson’s disease?
Following successful transplantation copper is removed properly from the body. However, liver transplantation is a major operation which has risks and it is still necessary to take medication and attend hospital for check-ups for the rest of the transplantee’s life.
Having a liver transplant doesn’t reverse any changes in the brain which may have occurred before the transplant but it will stop further damage to the brain.
If I have Wilson’s disease, will my children have it?
Not unless your partner is a carrier of the gene. The risk of this is very low but is higher if your partner is related to you in any way.
After liver transplantation an individual will still pass the Wilson’s gene on to any children they have. This does not mean the child will also have Wilson’s disease as the child would need to inherit a Wilson’s disease gene from both parents.
Should family members be screened for Wilson’s disease?
Brothers and sisters definitely should be tested. It can be very helpful to speak to a genetic counsellor before having a test. A genetic counsellor is a qualified professional who will discuss a genetic disease with an affected individual, and their family.
They can explain the disease in detail and also help parents to understand the pros and cons of genetic testing.
Can women with Wilson’s disease have successful pregnancies?
Many women with well-controlled Wilson’s disease have had successful and safe pregnancies whilst being treated. It is advisable to inform your specialist if you plan to become pregnant as they may want to review the doses of some of your medications.