To the Editor.
—As neurologists who frequently treat patients with neurosyphilis, we noted the article by Wiesel et al1 and the editorial by Felman2 in the March 1985 Archives in which a decision-analysis model is used to determine the risk-benefit ratio of cerebrospinal fluid (CSF) examination in the management of asymptomatic syphilis of more than one year's duration. Their conclusion, that CSF examination, via lumbar puncture (LP), is "not desirable" in routine management of these patients, is in contrast to our own clinical experience and, we believe, the published literature.Wiesel et al state that the LP is useful only to assure that patients with asymptomatic neurosyphilis are identified so subsequent spinal fluid examinations may be performed as a monitor of response to treatment. We agree; this is the approach proposed by Dattner et al3 in 1951. Wiesel et al, however, question this approach because (1) there