To the Editor.
—The case history in the article by Brewer and coworkers1 is another example of how dangerous it may be to start treatment with penicillamine in a patient with Wilson's disease and neurologic signs. Not infrequently the neurologic signs increase in the first weeks of treatment. It is our experience that a dramatic clinical recovery may occur after discontinuation of penicillamine therapy and institution of zinc therapy.2-4 It is difficult to understand why Brewer and coworkers waited so long to switch over to zinc therapy in their patient. In 1983, they had already stated that the "European" experience with oral zinc sulfate provided some reassurance for the use of zinc in cases of penicillamine intolerance.5 In our opinion, it would have been better to start treatment with zinc in this patient.In the Netherlands, zinc sulfate (200 to 300 mg three times a day) has
Hoogenraad TU, Van Hattum J. Zinc Therapy as the Initial Treatment for Wilson's Disease. Arch Neurol. 1988;45(4):373–374. doi:10.1001/archneur.1988.00520280015007
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