Community general practitioners

Case 3-A 20 year old man had been treated with penicillamine for severe intention tremor and dysarthria.He responded well but later stopped his medication and his symptoms recurred.Treatment was restarted using penicillamine and zinc sulphate.After two weeks there was no improvement and he had developed severe vomiting.Zinc was stopped and he recovered completely over six months on penicillamine alone.Case 4-A 14 year old girl presented with severe dystonia, frequent painful muscular spasms, dysarthria, and dysphagia.Penicillamine rapidly induced a severe thrombocytopenia and had to be stopped.She was -treated for a year with trientine with no appreciable clinical improvement although the blood and urine copper concentrations im- proved satisfactorily.At the end of a year zinc acetate, 84 mg (50 mol Zn + +) three times a day, was added to her treatment.She made a slow but significant improvement.After six months she was able to attend a school for the physically handicapped although she still used a wheelchair.No two patients with Wilson's disease are ever the same, either clinically or in their response to treatment.The reasons for this remain obscure.Zinc sulphate is not a panacea for the treatment of Wilson's disease but may be a valuable addition to the treatments now available.Careful evaluation in a large series would be helpful.