Psychosis and epileptic seizures in Wilson's disease with predominantly white matter lesions in the frontal lobe

Although psychiatric symptoms are not rare in Wilson's disease (WD), their association with epileptic seizures has not been reported. We describe three patients with such clinical manifestations who had predominantly cerebral white matter lesions in the frontal lobe. There were two men and one woman with ages ranging from 20 to 26 yr. The early presentations were psychiatric symptoms and epileptic seizures with or without secondary generalization. The psychiatric features were usually misinterpreted as schizophrenia-like disease and the diagnosis was delayed. The cerebral white matter lesions on magnetic resonance imaging (MRI) were usually asymmetric and mainly restricted to the frontal lobes. The present observation suggests that early onset of psychiatric manifestations and seizures commonly occur in WD with frontal white matter lesions.