Fetal Neurology (The International Review of Child Neurology)

Some of the most curious conditions seen by clinicians are the aberrations of movement that reflect dysfunction of the motor control circuits of the brain. The manifestations of these disor­ ders may include grossly excessive motions (for example, chorea, tics, myoclonus, tremor), too little movement (parkinsonism or the akinetic rigid syndromes), or excessive postures (dystonia). The disorders may be familial (such as Huntington's disease), iatrogenic (such as tardive dyskinesia or levodopa-induced chorea), or, in many cases, sporadic and idiopathic (as in Parkinson's disease). The pathologic spectrum of these conditions runs the gamut from no discernible cerebral involvement, as in the case of idiopathic torsion dystonias or essential tremor, to widespread involvement of the cen­ tral nervous system, as in the case of progressive supranuclear palsy. A few decades ago, many of these conditions were thought to be psychogenic. We now recog­ nize that this spectrum of diseases is primarily organic. Nevertheless, in some patients the disorder has a functional basis, and it is these patients, especially, that present some of the greatest challenges. This excellent, comprehensive text is devoted to problems that neurologists categorize as movement disorders. By convention, the term "movement disorders" typically excludes the ataxias (incoordination of movement) or condi­ tions involving certain of the final common motor pathways (that is, spasticity or corticospinal tract dysfunction). Thus, the concept of move­ ment disorders primarily encompasses condi­ tions that vary on a continuum from too much to too little movement. Interest in the field of movement disorders has grown rapidly in the past 10 to 20 years, and a substantial body of literature has been devoted to this area. The authors of this text have done a commendable job in succinctly organizing and presenting a vast array of material. Both au­ thors are highly respected clinician-researchers specializing in the area of movement disorders, and the text reflects their broad and in-depth knowledge. The reader benefits from having the entire text written by only two authors (unlike some comprehensive medical texts in which each chapter is written by a different author). Hence, this text is well organized, with good continuity from chapter to chapter and a consistency of quality that allows the book to be truly compre­ hensive. The text begins with an introduction to the subject of movement disorders that focuses on our current understanding of the electrophysiologic features of normal and abnormal move­ ment, as well as the neurochemical anatomy of the extrapyramidal motor system. Although this introduction is well written, a wealth of material is covered, and I suspect that the unini­ tiated may have difficulty assimilating all the material summarized in this complex chapter. Some of the subsequent chapters are devoted to specific conditions such as Huntington's dis­ ease, Parkinson's disease, and Wilson's disease, but most of the chapters are subdivided accord­ ing to the general category of movement disor­ ders (for example, chorea, dystonia, or my­ oclonus). The discussions of each category are complete, including descriptions of signs and symptoms, pathophysiologic features, differen­ tial diagnosis, and treatment. Unfortunately, this is not a book that will teach the medical student or intern how to recog­ nize these various conditions, because the clini­ cal nuances necessary for correctly distinguish­ ing them cannot be derived solely from written material. In future editions of the book, it might be useful to add an accompanying videotape of patients with the various conditions. The focus of this book does not lie in the specifics of medical therapy. For the physician seeking dosage guidelines or a cookbook ap-