Tremor is a recognised neurological manifestation of Wilson's disease. This protocol addresses the patient whose tremor has not been adequately controlled by a first benzodiazepine regimen, and for whom a further structured step is needed.
The previous line consisted of benzodiazepines (alprazolam or clonazepam), with the clinical goal of achieving meaningful relief and reduction of tremor. Escalation to this protocol is triggered when that goal remains unmet.
Where tremor causes significant disability and prior therapy has not achieved adequate control, the structured protocol considers a targeted neurostimulation or neurosurgical intervention. The full protocol specifies eligibility, the conditions under which this step is appropriate, and the evidence behind it — none of which are detailed here.
Relief and meaningful reduction of tremor.
DOI: 10.1016/j.jhep.2024.11.007
In the case of severe disability due to tremor, and after long-term anti-copper treatment, deep brain stimulation (DBS) of the subthalamic regions or thalamus or thalamotomy, should be considered in light of the promising outcomes from several single case reports, but more studies are needed.