Objective: To systematically evaluate multimodal evoked potentials (VEP, BAEP, SSEP, MEP) and full-field ERG in symptomatic WD patients and asymptomatic at-risk siblings compared to healthy controls, and assess their potential as biomarkers for early detection, disease monitoring, and therapeutic response evaluation.

Conventional diagnostic approaches in Wilson's disease (WD) often fail to detect early or subclinical neurological involvement, particularly in asymptomatic at-risk family members. Electrophysiological techniques offer sensitive, objective measures of neural pathway integrity that may reveal functional disturbances preceding structural MRI changes.

A prospective observational study (February 2024-March 2025) enrolled 40 symptomatic WD patients (mean age 20.2±5.95 years), 10 asymptomatic family members, and 20 age-matched controls. Comprehensive electrophysiological assessment included pattern-reversal VEP, BAEP, median nerve SSEP, transcranial magnetic stimulation MEP, and ISCEV-standard full-field ERG. Clinical severity was assessed using the MDS-Global Assessment Scale. Follow-up evaluation at 6 months assessed treatment response and disease progression using ANOVA and correlation analyses.

Electrophysiological techniques in Wilson’s disease can detect functional abnormalities that may precede overt clinical symptoms, and subclinical changes are observable in some asymptomatic individuals. Multimodal evoked potentials and ERG show promise for supplementing conventional assessment methods; further studies are warranted to clarify their role in early diagnosis and longitudinal monitoring.