—We wish to respond to certain elements in the accompanying LETTERS TO THE EDITOR by Hoogenraad and Van Hattum and by Pall and coworkers concerning our recent article in the Archives.1Hoogenraad and Van Hattum say "it would have been better to start treatment with zinc" in the patient in the case report, and "it is difficult to understand why Brewer and coworkers waited so long to switch over to zinc therapy." We made it clear in the article that the patient had been started on penicillamine by other physicians and the patient was not referred to us until six weeks after therapy had been initiated. As we said in the article, we did not switch the patient over to zinc therapy at that point, because we believed that the patient had already been through the syndrome of neurologic worsening from penicillamine. As our data show in the Archives
Brewer GJ, Yuzbasiyan-Gurkan V. Deterioration of Wilson's Disease Following the Start of Penicillamine Therapy-Reply. Arch Neurol. 1989;46(4):360–361. doi:https://doi.org/10.1001/archneur.1989.00520400014008
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