23rd July 2023

A 19-year-old presents with a tremor and muscle stiffness. His mother is worried that he is acting out of character

A 19-year-old presents with a tremor and muscle stiffness. His mother is worried that he is acting out of character and seems to be very forgetful. He has no past medical history. He has just started an apprenticeship. He drinks 8 units of alcohol per week. He does not smoke or use any recreational drugs.

On examination, you note some slurred speech. He has a resting tremor in his right hand and rigidity in that same limb. He is ataxic in both upper limbs.

Your investigations confirm a diagnosis of Wilson’s disease with no hepatic involvement.

What is the first line treatment?

Select the SINGLE most appropriate option from the list below. Select ONE option only.