Wilson's Disease

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Abstract
To the Editor. —Our experience with both penicillamine and/or zinc worsening neurologic symptoms agrees with that of Brewer et al.1 The exact cause of this initial exacerbation of symptoms is different with these two types of therapy, as we know from 22 years of experience using penicillamine and trace elements as therapy.2-5 Oral zinc merely displaces copper in the body so that serum copper levels increase for as long as three to four months, since excess copper is normally excreted slowly. Hallucinations may increase, the incidence of seizures may increase, paranoia with a higher serum copper level may increase, and retinitis may worsen. Therefore, in paranoid patients or those with hypercupremic retinitis, we start therapy with penicillamine, which directly aids the urinary excretion of copper (also zinc, iron, manganese, and chromium). These important essential elements should be given as a supplement when penicillamine is used. Both penicillamine and

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