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The Practical Management of Spasticity in Children and Adults
Mayo Clio Proc, December 1991, Vol 66
is that all information is relevant to the day-to-day practice of adult immunization. No extraneous or esoteric information is included. The task force demonstrated great insight in including information on implementing programs for adult immunization and discussing overlooked opportunities for vaccination of adults in hospitals, emergency departments, and outpatient facilities. The organization both by type of patient and by specific vaccine enhances the usability of the guidebook. Although the book was published in 1990, readers are advised that the field of vaccinology is dynamic and that important changes have occurred since publication of this edition. In particular, the Centers for Disease Control now recommends a two-dose policy for measles immunity. Students entering post-secondary schools and health-care workers (born after 1956) are advised to receive a second dose of measles vaccine. A third Haemophilus influenza type B conjugate vaccine, which allows initiation of the immunization series as young as age 2 months, is available, as is a new typhoid vaccine-an orally administeredenteric-coated preparation that causes minimal side effects and has immunogenicity equal to that of the parenteral vaccine. Without reservation, I recommend that every practicing physician own or have access to this information-packed manual. In addition, this text deserves a place in medical libraries, libraries for medical students and house officers, nursing homes, clinics, emergency departments, public health departments, and other places where medical care is provided for adults. This superb and clinically useful resource is an incredible bargain. Indeed, not owning or having access to this manual would be a "missed opportunity." Gregory A. Poland, M.D. Division of General Internal Medicine
Radiation Therapy of Benign Diseases: A Clinical Guide (Medical Radiology: Diagnostic Imaging and Radiation Oncology series), by Stanley E. Order and Sarah S. Donaldson, 212 pp, $69.50, New York, Springer-Verlag, 1990 This handy, small volume carefully summarizes the current status of treatment of benign conditions under the circumstances of American practice of radiation oncology. The authors surveyed 834 radiation oncologists nationwide and have included with each entity a statement of the proportion of those who would treat the discussed condition. Each disease entity is briefly analyzed; a tabular summary of references, including the number of patients, treatment, results, and notes, follows. After the tables are presented, the references are listed, including those referred to in the tables.
BOOK REVIEWS 1291
The listing of benign conditions is relatively complete, and the resultant survey of the status of management for benign diseases should be extremely useful for radiation oncologists. A deficiency ofthe book is the poorly constructed binding; it warped within a few months. This 2l2-page text with extensive tables costs $69.50, a price that seems excessive for the size of the publication. John D. Earle, M.D. Division of Radiation Oncology
The Practical Management of Spasticity in Children and Adults, edited by Mel B. Glenn and John Whyte, 325 pp, with illus, $39.50, Philadelphia, Lea & Febiger, 1990 Spasticity is one of several abnormalities of muscle tone and activity that occur in various conditions and diseases that affect both children and adults. It may interfere with growth, development, motor function and skills, communication, and bowel and bladder function. Because this condition afflicts the lives of many persons in numerous ways, the management of spasticity encompasses several therapeutic strategies and involves various rehabilitative health-care providers. The authors have produced a comprehensive text that covers the spectrum of spasticity, from neurophysiologic characteristics to evaluation and management. Although the title of the book and the authors' preface identify clinical management as the primary focus, a third of the text (approximately the first 100 pages) is devoted to the neurophysiologic aspects of spasticity and their evaluation, along with a chapter on motor leaming and releaming research and therapy. The average clinician may ~nd this material somewhat beyond the day-to-day management of spasticity; however, the basic science and theoretic background, which is relevant and important to a complete discussion of the management of spasticity, is provided. The chapters on the various aspects of management will encourage most interested medical personnel to buy this publication. The chapter on the importance of postural alignment and positioning is well organized and leads to the two chapters on casting, splinting, and orthotic principles of management. The spectrum of physical modalities and the mechanisms by which they modify spasticity are thoroughly reviewed. This section is written by occupational and physical therapists and accurately represents the useful contributions of their respective professions to the management of spasticity. Neurosurgical and orthopedic options of management are dealt with effectively by surgeons in each profession. The chapter on neurosurgical aspects highlights the recent advances of selective dorsal rhizotomy and implantable pumps
Mayo CUn Proc, December 1991, Vol 66
1292 BOOK REVIEWS
for intrathecal administration of neuromodulating drugs, such as baclofen. Several physiatrists contributed to the text by specifically addressing pharmacologic interventions and use of injections, including nerve blocks and motor point blocks. Physiatrists also wrote the two concluding chapters that correlate many of the interventions with case examples of the management of spasticity after traumatic brain injury and in multiple sclerosis. This book fills a distinct gap in the literature on a difficult subject, which previously was dispersed throughout the basic science literature and journals that represent various specialties, and it consolidates the information in a single useful source. I recommend this publication to all healthcare professionals who are involved in the management of spasticity. David L. Nash, M.D. Department of Physical Medicine and Rehabilitation
Handbook of Multiple Sclerosis (Neurological Disease and Therapy, Vol 8), edited by Stuart D. Cook, 513 pp, with illus, $115, New York, Marcel Dekker, 1990 The field of inflammatory-demyelinating diseases of the human central nervous system is an active area of research. In this book, Dr. Cook invited many leading basic and clinical scientists in this area to summarize the new knowledge. The first part of the text is priinarily devoted to advances in the basic sciences relevant to murtiple sclerosis (epidemiology, genetics, virology, and immunopathogenesis). The middle section deals with more clinically pertinent areas (clinical features, pathologic and pathophysiologic manifestations, and diagnostic studies--cerebrospinal fluid, evoked potentials, and neuroimaging). The final part reviews what is known and what advances are anticipated in therapeutic options. With few exceptions, the chapters are well written, the illustrations were carefully chosen, and each author compiled extensive and current reference lists. As with many multiauthored books, the writing is occasionally uneven, but most coauthors resisted the temptation to emphasize their own contributions at the expense of other work in the field. Dr. Cook successfully achieved his objective. The major advances are presented clearly and concisely. This volume will be most useful to residents and fellows in neurology who are near the end of their training, to neurologic clinicians who are interested in comprehensive and current advances in the basic sciences pertinent to multiple sclerosis, and to both basic and clinical investigators who work in this area and want to review or update their understanding of the related areas of
research. The chapters that address the basic sciences of human demyelinating disease, including those that deal with pathologic and pathophysiologic features, will be particularly well received by practicing neurologists eager to update their knowledge of these topics. This handbook would have appealed to a wider readership, including medical students and nonneurologic clinicians who are responsible for the care of these patients (such as family practitioners and specialists in internal medicine and physical medicine and rehabilitation), if several additional clinical topics would have been reviewed. T~ differential diagnosis of multiple sclerosis receives almost no coverage. Little information is devoted to the natural history of the disease, syndromes of chronic progressive myelopathy, isolated brainstem dysfunction, or optic neuropathies. In addition, the following topics are addressed in a cursory fashion: multiple sclerosis that occurs at the extremes of life (onset before age 15 or after age 55 years), management of pregnant patients (the effectof pregnancy on the course of the disease and of the disease on the dynamics of the family), and psychosocial issues related to premature disability, depression, and suicide. The part of the text that focuses on therapeutic issues is generally well done. Most authors carefully state that the experimental treatment or treatments they discuss remain unproved. The case for plasma exchange in combination with cyclophosphamide and adrenocorticotropic hormone or corticosteroids for both severe exacerbations and progressive disease is overstated. Although 150 pages are devoted to therapeutic options, none of this material mentions that paroxysmal disorders characteristically respond dramatically to low doses of carbamazepine, phenytoin, or baclofen, that the emotional incontinence that accompanies pseudobulbar palsy often responds to a low dose of amitriptyline hydrochloride, or that recent studies suggest that intrathecally administered baclofen may be helpful for treating intractable spasticity. The common, and often troublesome, pain syndromes that are encountered in patients with moderately advanced multiple sclerosis are only superficially reviewed. John H. Noseworthy, M.D. Department of Neurology
Professional Voice: The Science and Art of Clinical Care, by Robert Thayer Sataloff, 542 pp, with illus, $95, New York, Raven Press, 1991 Dr. Robert Thayer Sataloff is one of a few otolaryngologists in the United States devoted to the treatment of professional singers, actors, and public speakers who experience difficulty with their voices because of laryngeal and respiratory diseases, faulty techniques of voice production, and psychologic
is that all information is relevant to the day-to-day practice of adult immunization. No extraneous or esoteric information is included. The task force demonstrated great insight in including information on implementing programs for adult immunization and discussing overlooked opportunities for vaccination of adults in hospitals, emergency departments, and outpatient facilities. The organization both by type of patient and by specific vaccine enhances the usability of the guidebook. Although the book was published in 1990, readers are advised that the field of vaccinology is dynamic and that important changes have occurred since publication of this edition. In particular, the Centers for Disease Control now recommends a two-dose policy for measles immunity. Students entering post-secondary schools and health-care workers (born after 1956) are advised to receive a second dose of measles vaccine. A third Haemophilus influenza type B conjugate vaccine, which allows initiation of the immunization series as young as age 2 months, is available, as is a new typhoid vaccine-an orally administeredenteric-coated preparation that causes minimal side effects and has immunogenicity equal to that of the parenteral vaccine. Without reservation, I recommend that every practicing physician own or have access to this information-packed manual. In addition, this text deserves a place in medical libraries, libraries for medical students and house officers, nursing homes, clinics, emergency departments, public health departments, and other places where medical care is provided for adults. This superb and clinically useful resource is an incredible bargain. Indeed, not owning or having access to this manual would be a "missed opportunity." Gregory A. Poland, M.D. Division of General Internal Medicine
Radiation Therapy of Benign Diseases: A Clinical Guide (Medical Radiology: Diagnostic Imaging and Radiation Oncology series), by Stanley E. Order and Sarah S. Donaldson, 212 pp, $69.50, New York, Springer-Verlag, 1990 This handy, small volume carefully summarizes the current status of treatment of benign conditions under the circumstances of American practice of radiation oncology. The authors surveyed 834 radiation oncologists nationwide and have included with each entity a statement of the proportion of those who would treat the discussed condition. Each disease entity is briefly analyzed; a tabular summary of references, including the number of patients, treatment, results, and notes, follows. After the tables are presented, the references are listed, including those referred to in the tables.
BOOK REVIEWS 1291
The listing of benign conditions is relatively complete, and the resultant survey of the status of management for benign diseases should be extremely useful for radiation oncologists. A deficiency ofthe book is the poorly constructed binding; it warped within a few months. This 2l2-page text with extensive tables costs $69.50, a price that seems excessive for the size of the publication. John D. Earle, M.D. Division of Radiation Oncology
The Practical Management of Spasticity in Children and Adults, edited by Mel B. Glenn and John Whyte, 325 pp, with illus, $39.50, Philadelphia, Lea & Febiger, 1990 Spasticity is one of several abnormalities of muscle tone and activity that occur in various conditions and diseases that affect both children and adults. It may interfere with growth, development, motor function and skills, communication, and bowel and bladder function. Because this condition afflicts the lives of many persons in numerous ways, the management of spasticity encompasses several therapeutic strategies and involves various rehabilitative health-care providers. The authors have produced a comprehensive text that covers the spectrum of spasticity, from neurophysiologic characteristics to evaluation and management. Although the title of the book and the authors' preface identify clinical management as the primary focus, a third of the text (approximately the first 100 pages) is devoted to the neurophysiologic aspects of spasticity and their evaluation, along with a chapter on motor leaming and releaming research and therapy. The average clinician may ~nd this material somewhat beyond the day-to-day management of spasticity; however, the basic science and theoretic background, which is relevant and important to a complete discussion of the management of spasticity, is provided. The chapters on the various aspects of management will encourage most interested medical personnel to buy this publication. The chapter on the importance of postural alignment and positioning is well organized and leads to the two chapters on casting, splinting, and orthotic principles of management. The spectrum of physical modalities and the mechanisms by which they modify spasticity are thoroughly reviewed. This section is written by occupational and physical therapists and accurately represents the useful contributions of their respective professions to the management of spasticity. Neurosurgical and orthopedic options of management are dealt with effectively by surgeons in each profession. The chapter on neurosurgical aspects highlights the recent advances of selective dorsal rhizotomy and implantable pumps
Mayo CUn Proc, December 1991, Vol 66
1292 BOOK REVIEWS
for intrathecal administration of neuromodulating drugs, such as baclofen. Several physiatrists contributed to the text by specifically addressing pharmacologic interventions and use of injections, including nerve blocks and motor point blocks. Physiatrists also wrote the two concluding chapters that correlate many of the interventions with case examples of the management of spasticity after traumatic brain injury and in multiple sclerosis. This book fills a distinct gap in the literature on a difficult subject, which previously was dispersed throughout the basic science literature and journals that represent various specialties, and it consolidates the information in a single useful source. I recommend this publication to all healthcare professionals who are involved in the management of spasticity. David L. Nash, M.D. Department of Physical Medicine and Rehabilitation
Handbook of Multiple Sclerosis (Neurological Disease and Therapy, Vol 8), edited by Stuart D. Cook, 513 pp, with illus, $115, New York, Marcel Dekker, 1990 The field of inflammatory-demyelinating diseases of the human central nervous system is an active area of research. In this book, Dr. Cook invited many leading basic and clinical scientists in this area to summarize the new knowledge. The first part of the text is priinarily devoted to advances in the basic sciences relevant to murtiple sclerosis (epidemiology, genetics, virology, and immunopathogenesis). The middle section deals with more clinically pertinent areas (clinical features, pathologic and pathophysiologic manifestations, and diagnostic studies--cerebrospinal fluid, evoked potentials, and neuroimaging). The final part reviews what is known and what advances are anticipated in therapeutic options. With few exceptions, the chapters are well written, the illustrations were carefully chosen, and each author compiled extensive and current reference lists. As with many multiauthored books, the writing is occasionally uneven, but most coauthors resisted the temptation to emphasize their own contributions at the expense of other work in the field. Dr. Cook successfully achieved his objective. The major advances are presented clearly and concisely. This volume will be most useful to residents and fellows in neurology who are near the end of their training, to neurologic clinicians who are interested in comprehensive and current advances in the basic sciences pertinent to multiple sclerosis, and to both basic and clinical investigators who work in this area and want to review or update their understanding of the related areas of
research. The chapters that address the basic sciences of human demyelinating disease, including those that deal with pathologic and pathophysiologic features, will be particularly well received by practicing neurologists eager to update their knowledge of these topics. This handbook would have appealed to a wider readership, including medical students and nonneurologic clinicians who are responsible for the care of these patients (such as family practitioners and specialists in internal medicine and physical medicine and rehabilitation), if several additional clinical topics would have been reviewed. T~ differential diagnosis of multiple sclerosis receives almost no coverage. Little information is devoted to the natural history of the disease, syndromes of chronic progressive myelopathy, isolated brainstem dysfunction, or optic neuropathies. In addition, the following topics are addressed in a cursory fashion: multiple sclerosis that occurs at the extremes of life (onset before age 15 or after age 55 years), management of pregnant patients (the effectof pregnancy on the course of the disease and of the disease on the dynamics of the family), and psychosocial issues related to premature disability, depression, and suicide. The part of the text that focuses on therapeutic issues is generally well done. Most authors carefully state that the experimental treatment or treatments they discuss remain unproved. The case for plasma exchange in combination with cyclophosphamide and adrenocorticotropic hormone or corticosteroids for both severe exacerbations and progressive disease is overstated. Although 150 pages are devoted to therapeutic options, none of this material mentions that paroxysmal disorders characteristically respond dramatically to low doses of carbamazepine, phenytoin, or baclofen, that the emotional incontinence that accompanies pseudobulbar palsy often responds to a low dose of amitriptyline hydrochloride, or that recent studies suggest that intrathecally administered baclofen may be helpful for treating intractable spasticity. The common, and often troublesome, pain syndromes that are encountered in patients with moderately advanced multiple sclerosis are only superficially reviewed. John H. Noseworthy, M.D. Department of Neurology
Professional Voice: The Science and Art of Clinical Care, by Robert Thayer Sataloff, 542 pp, with illus, $95, New York, Raven Press, 1991 Dr. Robert Thayer Sataloff is one of a few otolaryngologists in the United States devoted to the treatment of professional singers, actors, and public speakers who experience difficulty with their voices because of laryngeal and respiratory diseases, faulty techniques of voice production, and psychologic