Letter to the Editor
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2021; 27(39): 6733-6736
Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6733
Impact of COVID-19 pandemic on the neuropsychiatric status of Wilson’s disease
Giuseppe Lanza, Massimiliano Godani, Raffaele Ferri, Alberto Raggi
Giuseppe Lanza, Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania 95123, Italy
Giuseppe Lanza, Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina 94018, Italy
Massimiliano Godani, Neurology Unit, Sant’Andrea Civic Hospital, La Spezia 19121, Italy
Raffaele Ferri, Department of Neurology IC, Sleep Research Center, Oasi Research Institute-IRCCS, Troina 94018, Italy
Alberto Raggi, Unit of Neurology, G.B. Morgagni - L. Pierantoni Hospital, Forlì 47121, Italy
Author contributions: Lanza G designed the study; Godani M and Raggi A performed research; Ferri R analyzed the data; Lanza G and Godani M wrote the letter; Ferri R and Raggi A revised the letter.
Conflict-of-interest statement: Dr. Ferri R declared a personal Participation on a Data Safety Monitoring Board or Advisory Board for Jazz in the past 36 mo. Drs. Lanza G, Godani M, and Raggi A declared no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Lanza, MD, PhD, MSc, Senior Academic Research, Assistant Professor, Consultant Neurologist, Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, Catania 95123, Italy. Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, Troina 94018, Italy glanza@oasi.en.it
Received: July 17, 2021
Peer-review started: July 17, 2021
First decision: August 9, 2021
Revised: August 11, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: October 21, 2021
Processing time: 94 Days and 8.2 Hours
Abstract

We have read with interest the Letter to the Editor by Drs. Zhuang and Zhong, who presented the clinical data of 68 patients with Wilson’s disease (WD) who were admitted to the hospital before and during the coronavirus disease 2019 (COVID-19) pandemic, and appreciated their findings on hepatic and some extrahepatic manifestations. Nevertheless, given the strong impact of the pandemic on patients with neurological and psychiatric disorders, we would have expected a worsening of the psychiatric and/or neurological impairments in these patients. In contrast, according to the authors, these manifestations remained, somewhat unexpectedly, unchanged. This finding is in contrast with most of the current literature that highlights not only an increased incidence of mental health disorders in the general population but also an exacerbation of neurological and psychiatric symptoms in patients with chronic diseases, especially in those with pre-existing neuropsychiatric disorders, such as WD. Although the study was mainly focused on the hepatic features of WD patients taking anti-copper treatment, a generic and cumulative definition of neurological and psychiatric manifestations, as in this study, does not allow for further considerations. Future studies during and after the pandemic are necessary to clarify the real impact, either direct or indirect, of the COVID-19 pandemic on the neurological and psychiatric symptoms of WD patients.

Keywords: Wilson’s disease; Extra-hepatic manifestations; Neuropsychiatric symptoms; COVID-19; Therapy; Resilience

Core Tip: In the interesting letter by Drs. Zhuang and Zhong, the psychiatric and neurological manifestations of 68 patients with Wilson’s disease who were treated with anti-copper therapy unexpectedly remained unchanged after the pandemic. Given the impact of the pandemic on patients with neurological and psychiatric disorders, a worsening in the severity or frequency of these manifestations could have been expected. The possible reasons underlying this finding, including the relatively small sample size, the effect of therapy, and the patients’ resilience, are discussed.