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Dangers of Interrupting Decoppering Treatment in Wilson's Disease-Reply

Christoph J. G. Lang, MD; Peter Rabas-Kolominsky, MD; Andreas Engelhardt, MD; Henning J. König, MD
Arch Neurol. 1994;51(10):973-973. doi:10.1001/archneur.1994.00540220018006
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In reply  Hoogenraad's comments regarding our letter to the editor1 strike us as somewhat inappropriate, missing the point in several aspects. We shall try to address these concisely.First, the passage "worsening of neurologic signs after the start of zinc therapy has never been described" is a verbatim quotation from Hoogenraad and Van Hattum.2 Nowhere does the word "paradoxical" appear. If they had meant it that way, they should have said so. We did not claim that we observed "paradoxical" worsening as defined by Hoogenraad.Second, it is not true that a worsening of Wilson's disease (WD) after the institution of oral zinc therapy had not been reported before. From his and Van Hattum's former correspondence,3 Hoogenraad knows well that Wiedmann,4,5 and Strohmeyer and Stremmel,4 saw distinct deterioration. Pfeiffer and Camo6 observed the same effect in some patients. Brewer et al,7 Scheinberg and

REFERENCES

Lang CJG, Rabas-Kolominsky P, Engelhardt A, Kobras G, König HJ.  Fatal deterioration of Wilson's disease after institution of oral zinc therapy . Arch Neurol . 1993;;50:1007-1008.
Hoogenraad TU, Van Hattum J.  Zinc therapy as the initial treatment for Wilson's disease . Arch Neurol . 1988;;45:373-374.
Hoogenraad TU, Van Hattum J.  Behandlung des Morbus Wilson . Dtsch Med Wochenschr . 1987;;112:942.
Wiedmann K-H.  Erwiderung auf'Behandlung des Morbus Wilson' von T. U. Hoogenraad und J. Van Hattum . Dtsch Med Wochenschr . 1987;;112:942-943.
Wiedmann K-H.  Die Wilson-Erkrankung: neue Alternativen zur D-Penicillamin-Behandlung?  In: Wiedmann K-H, ed. Therapeutische Probleme bei chronischen Lebererkrankungen . Berlin, Germany: Springer Verlag; 1989;: 88-99.
Pfeiffer CC, Camo B.  Wilson's disease . Arch Neurol . 1988;;45:247.
Brewer GJ, Yuzbasiyan-Gurkan V.  In reply . Arch Neurol . 1989;;46:360-361.
Scheinberg IH.  Sternlieb I. The efficacy of oral zinc therapy as an alternative to penicillamine for Wilson's disease . N Engl J Med . 1988;;318:323.
Walshe JM.  Treatment of Wilson's disease with zinc sulphate . BMJ . 1984;; 289:558-559.
Shimon I, Moses B, Sola B-A, Dolev E.  Hemolytic episode in a patient with Wilson's disease treated with zinc . Isr J Med Sci . 1993;;29:646-647.
Hoogenraad TU, Van Hattum J, Van den Hamer CJA.  Management of Wilson's disease with zinc sulphate: experience in a series of 27 patients . J Neurol Sci . 1987;;77:137-146.
Brewer GJ, Yuzbasiyan-Gurkan V.  Wilson disease . Medicine . 1992;;71:139-164.

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Lang CJG, Rabas-Kolominsky P, Engelhardt A, Kobras G, König HJ.  Fatal deterioration of Wilson's disease after institution of oral zinc therapy . Arch Neurol . 1993;;50:1007-1008.
Hoogenraad TU, Van Hattum J.  Zinc therapy as the initial treatment for Wilson's disease . Arch Neurol . 1988;;45:373-374.
Hoogenraad TU, Van Hattum J.  Behandlung des Morbus Wilson . Dtsch Med Wochenschr . 1987;;112:942.
Wiedmann K-H.  Erwiderung auf'Behandlung des Morbus Wilson' von T. U. Hoogenraad und J. Van Hattum . Dtsch Med Wochenschr . 1987;;112:942-943.
Wiedmann K-H.  Die Wilson-Erkrankung: neue Alternativen zur D-Penicillamin-Behandlung?  In: Wiedmann K-H, ed. Therapeutische Probleme bei chronischen Lebererkrankungen . Berlin, Germany: Springer Verlag; 1989;: 88-99.
Pfeiffer CC, Camo B.  Wilson's disease . Arch Neurol . 1988;;45:247.
Brewer GJ, Yuzbasiyan-Gurkan V.  In reply . Arch Neurol . 1989;;46:360-361.
Scheinberg IH.  Sternlieb I. The efficacy of oral zinc therapy as an alternative to penicillamine for Wilson's disease . N Engl J Med . 1988;;318:323.
Walshe JM.  Treatment of Wilson's disease with zinc sulphate . BMJ . 1984;; 289:558-559.
Shimon I, Moses B, Sola B-A, Dolev E.  Hemolytic episode in a patient with Wilson's disease treated with zinc . Isr J Med Sci . 1993;;29:646-647.
Hoogenraad TU, Van Hattum J, Van den Hamer CJA.  Management of Wilson's disease with zinc sulphate: experience in a series of 27 patients . J Neurol Sci . 1987;;77:137-146.
Brewer GJ, Yuzbasiyan-Gurkan V.  Wilson disease . Medicine . 1992;;71:139-164.

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