Measurements of serum ceruloplasmin level in patients with different movement disorders

Background: Serum ceruloplasmin level is frequently measured in patients with abnormal movements when suspecting Wilson’s disease. Recent evidence suggests the role of ceruloplasmin in the cascades of neuronal damage in Parkinson’s disease and other neurodegenerative disorders. Objectives: To compare the serum ceruloplasmin levels between patients with non-Wilsonian movement disorders and healthy controls. Methods: The authors obtained serum samples from patients attending Chulalongkorn Movement Disorders Clinic between October 2007 and January 2008 and from healthy blood donors at the Thai Red Cross Blood Bank. The authors studied the serum levels of ceruloplasmin, copper and γ-glutamyl transpeptidase (GGT). Results: Among 152 patients and 95 controls, mean age in patient group was higher than controls (58.9±14 vs. 38.2±10.4; p<0.001). Disease entities included: Parkinson’s disease (55%), essential tremor (11%), idiopathic focal dystonia (8.4%), parkinsonism-plus syndromes (8.4%), tardive syndromes (7.1%) and others. The mean ceruloplasmin level in patient group was significantly lower than controls (20.8±4.3mg/dl vs. 23.3±6.2mg/dl; p<0.001). In subgroup analysis, ceruloplasmin levels in Parkinson’s disease and essential tremor were lower than controls (p<0.001). Analysis according to etiologies of movement disorders showed reduced mean ceruloplasmin level in neurodegenerative disorders, but not in other etiologies, compared with controls (p<0.001). Linear regression indicated that female gender and GGT were factors that positively correlate with ceruloplasmin level; but not other factors i.e. age, disease duration. Conclusions: From our cohort, reduced serum ceruloplasmin level in non-Wilsonian movement disorders further supports a pathological role of ceruloplasmin in various movement disorders not limited to WD. Interestingly, ceruloplasmin levels in subgroups of Parkinson’s disease, essential tremor and neurodegenerative disorders were lower than controls. Such differential reduction of ceruloplasmin levels might be implemented as part of the diagnostic work-up in clinical practice.