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Book Reviews
December 2008

Clinical Diagnosis and Management of Dystonia

Arch Neurol. 2008;65(12):1677. doi:10.1001/archneur.65.12.1677

This is a comprehensive multi-author book about diagnosis and management of dystonia. Dystonia is a common movement disorder which is often misdiagnosed and overlooked both by patients and primary care physicians. The authors succeed in demonstrating that many dystonic disorders are now well-described as a result of a genetic defect affecting enzymes, channels, or other cell functions. The book is written by recognized experts from both sides of the Atlantic.

The book describes all features of dystonia in 23 chapters. The first chapters cover the diagnosis of dystonia. This is mostly made on clinical grounds for primary dystonia, whereas establishing a diagnosis of secondary dystonia may be costly and rather cumbersome because of the variety of differential diagnoses. The epidemiology of dystonia is then described and the authors claim that more data should be available to determine the true prevalence and incidence of the various forms of dystonia. A whole chapter is dedicated to the genetic forms of dystonia. The following chapters deal with pathophysiology, imaging, and a special section on DYT 1. The clinical characteristics of cervical, cranial, task-specific, and laryngeal dystonias are carefully described and modern treatment is outlined. In addition, valuable information is presented about dystonia-plus syndromes, heredodegenerative dystonia, drug-induced dystonia, and tardive dystonia. Paroxysmal dyskinesias are an exciting example of how genetic analyses have unravelled the organic basis of such abnormalities. An important chapter deals with the highly relevant subject of psychogenic dystonia, which is still the most common psychogenic movement disorder, although it seems to be rarer than originally assumed. In the following chapters modern drug therapy and the use of botulinum toxin are discussed. There is a well-illustrated chapter on surgical procedures available for the treatment of dystonia. I was impressed to also find some interesting chapters on physiotherapy in dystonic patients, the role of a specialist dystonia nurse, quality-of-life issues, and rating scales for dystonic patients.