Movement Disorders in Children (International Review of Child Neurology Series).

Fernando-Alvarez E, Aicardi J. London WC1V 6RL United Kingdom, Mac Keith Press, 2001, hardcover, 263 pp, illus, ISBN: 1-898-68323-9, $74.95.

Physical therapists who work with children with neurological disorders are challenged to make clinical decisions for patients whose movement dysfunctions are often poorly understood or downright mysterious. This slender volume, authored by 2 eminent pediatric neurologists with contributions from several experts in the field, helps to clarify and classify disorders in this area of neurological dysfunction.

This book was written as a resource for pediatricians and child neurologists and succinctly catalogs the various manifestations of movement dysfunction in children. The authors describe this volume as an effort to gather complete and current knowledge of children's movement disorders. They suggest that pediatricians can use this book to identify the source of, and clinical management for, movement dysfunctions that they may not commonly encounter in daily practice. Physicians who specialize in child neurology might welcome the book as a compact and accessible source of information related to this topic.

Chapter one, "General Concepts," provides definitions for terms used throughout the book and provides the framework for understanding how the authors classify movement dysfunctions. Functional organization of the basal ganglia in children with and without movement disorders, the main types of movement abnormalities, the clinical context of abnormal movements, and the distribution and classification of movement disorders in children are covered.

Chapter 2 is titled "Disorders in Which a Hypokinetic-Rigid Syndrome Is the Predominant Feature." These syndromes include juvenile idiopathic parkinsonism, early-onset Parkinson disease, X-linked dystonia-parkinsonism, rapid-onset dystonia-parkinsonism, juvenile Huntington disease, and neuronal intranuclear inclusion disease. Interventions to address the symptoms are included. The authors conclude the chapter with the statement, "Physiotherapy and psychological support are necessary in all cases." (p36)

Movement disorders with tremor as the principal symptom are addressed in chapter 3. The chapter begins with an introduction to the topic and describes how the authors classified the disorders into the categories of primary tremors and secondary tremors. A discussion of symptomatic management concludes the chapter.

Chapter 4 describes disorders that exhibit chorea or ballismus. After a brief introduction and overview of classification, choreatic and ballistic movement disorders are presented and suggested interventions are included.

Chapter 5 is titled "Movement Disorders With Dystonia or Athetosis as the Main Clinical Manifestation." Two methods of classification are presented: (1) according to evolution and topography (acute, transient, paroxysmal, or chronic) and (2) according to etiology (primary or secondary).

Chapter 6 addresses diseases with several types of movement disorders, including Wilson disease, Hallervorden-Spatz disease, multiple system atrophies, and progressive calcification of the basal ganglia.

Paroxysmal movement disorders, which include primary and secondary dystonias such as benign paroxysmal torticollis of infancy and paroxysmal tonic upgaze deviation of infancy, are discussed in chapter 7. The chapter concludes with a discussion of nosology and the differential diagnosis of paroxysmal movement disorders.

Chapter 8 presents movement disorders with myoclonus as the primary symptom. Physiological myoclonus, nonepileptic myoclonus, and epileptic myoclonus are discussed.

Tic disorders are the topic in chapter 9. Age of onset, epidemiology, and associated disturbances are discussed after a brief introduction. Transient and chronic tics, Tourette syndrome, and secondary tics are addressed.

Drug-induced movement disorders are discussed in chapter 10. A variety of pharmacologic agents are discussed. Neuroleptic and anti-epileptic drugs are the 2 primary categories of medications. The chapter ends with a listing of movement disorders caused by other drugs.

Chapter 11 deals with movement disorder in cerebral palsy and miscellaneous movement disorders in childhood such as delayed-onset dyskinesia, rhythmic habit patterns, synkinesias and mirror movements, and restless legs syndrome.

Ancillary investigations are presented in the concluding chapter. Section 1 of this chapter presents an overview of how abnormal movements may be studied using electromyography and movement-related cortical potential. Studies with positron emission tomography are presented in section 2. Section 3 discusses examination of biopsied tissue.

This volume addresses very complex neurological disorders that result in movement dysfunction in children. The authors adhere to their purpose by exhaustively presenting the current knowledge on the topic in a very concise format. The text is generously illustrated with photographs that illustrate the clinical manifestations of many of the disorders discussed. Tables and explanatory figures are presented to augment the text. Chapters 2 through 11 have a similar structure, with an introduction that explains how the disorders were classified, followed by clear descriptions that include clinical features, related laboratory investigations, differential diagnosis, pathology, pathophysiology, and medical treatment. Extensive references are provided throughout the text and in reference lists at the end of each chapter.

Movement Disorders in Children is very narrow in scope and is consistent with its stated purpose. However, interventions beyond the use of medications and surgery are not discussed. There are only occasional references to communication, collaboration, and referral with other health care professionals who might offer interventions for children with movement disorders.

This book's intended audience is the physician who works with children. Physical therapists who work extensively with children with complex neurological conditions might find this book helpful because it is so comprehensive and focused at the same time. Faculty who teach in physical therapist education programs might use this book as an adjunct text. The references are exhaustive and provide historical as well as current contributions about the topic.

Mary Jean Gelsomino, PT
Utica College
Utica, NY

Ms Gelsomino is Assistant Professor in the Physical Therapy Program, with primary teaching responsibilities in neurological rehabilitation and a research interest in the physical activity of children.