Objective: Wilson disease (WD) manifesting as seizure is rare. Rolandic epilepsy as presenting feature of WD has been reported only once before.
Methods: A 6-year-old girl of nonconsanguineous parentage presented with focal seizures. There was associated fatty hepatomegaly and elevated aminotransferases.
Results: Brain magnetic resonance imaging (MRI) was unremarkable. Electroencephalogram demonstrated bilateral centrotemporal spike classical of Rolandic epilepsy. Serum ceruloplasmin was low and 24-h urinary copper levels were elevated. Genetic mutational analysis showed she carried the rare homozygous p.Asn1270Ser genetic mutation. Administration of d-penicillamine gradually halted seizure activity together with near normalization of serum aminotransferases.
Conclusions: Rolandic epilepsy associated with elevated liver enzymes should undergo evaluation for WD. Chelators have a salutary effect on seizure activity, as well as elevated serum aminotransferases.
Keywords: ALP, Alkaline phosphatase; ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; EEG, Electroencephalography; GGT, Gamma glutamyl transferase; WD, Wilson disease; centrotemporal spikes; copper; focal seizure; transaminase.
© 2020 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.