What is the first-line treatment for managing neurological complications in patients with Wilson's disease?

The first-line treatment for managing neurological complications in patients with Wilson's disease is zinc. Zinc acts as a copper chelator and helps to reduce copper absorption from the gastrointestinal tract, effectively decreasing copper accumulation in the body. This is particularly important in Wilson's disease, where excess copper leads to neurological and hepatic complications.

Unlike other treatments, zinc is well-tolerated, relatively safe, and does not have the side effects associated with chelating agents like penicillamine and trientine, which can sometimes exacerbate neurological symptoms or cause adverse reactions. Zinc supplementation can help stabilize patients and mitigate the neurological effects without the significant risks that chelating agents involve.

Although penicillamine has historically been used in Wilson's disease, it can lead to worsening neurological symptoms at the outset of treatment in some patients, making it less ideal as a first-line option for neurological manifestations. Trientine, while sometimes used, is generally considered when other treatments are not suitable or effective. Sodium thiosulfate is not typically indicated for Wilson's disease management.