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Christoph J. G. Lang, MD; Peter Rabas-Kolominsky, MD; Andreas Engelhardt, MD
Department of Neurology University of Erlangen-Nuremberg Schwabachanlage 6 D-91054 Erlangen, Germany

Henning J. König, MD
Erlangen, Germany

Arch Neurol. 1994;51(10):973.

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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 . . . [Full Text PDF of this Article]

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