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Clinical evaluation and management of spasticity
  1. Michael Barnes

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    Edited by David A Gelber and Douglas R Jeffery (Pp 385, US$125.00). Published by Humana Press, Totowa, 2002. ISBN 0-89603-636-7

    This is a useful and interesting book. It is increasingly recognised that several treatment strategies can be beneficial in the management of spasticity, particularly using more recent drugs such as tizanidine and botulinum toxin. The book is a comprehensive review of the subject. No important topics are missed, although the length and thoroughness of the chapters do vary to a significant degree.

    The book opens with a brief chapter on the physiology and pharmacology of spasticity. Although the book is targeted towards a clinical audience, and as such is a practical textbook, it is a pity that this opening chapter is so brief with regard to the neurophysiology of spasticity. An understanding of the underlying principles is important for logical treatment. Alex Dromerick produces a good chapter covering the clinical features of spasticity and a brief resume of complications. This is followed by an excellent chapter on the measurement of spasticity by David Good, which I found to be one of the most useful summaries of this field that I have read for some time. My major disappointment in the book is the brevity of the following chapter on physical and occupational approaches. The involvement of a neurological physiotherapist in the management of spasticity is vital and while this chapter is thorough it is too brief and fails to do justice to the key involvement of a physiotherapist in the spasticity team. This defect is partially overcome with an excellent subsequent chapter on orthotic management, which is a very clear and useful overview of an increasingly complex subject. The standard pharmacological interventions (baclofen, tizanidine, dantrolene, and the benzodiazepines) are thoroughly covered in the ensuing chapters with an additional brief chapter on alternative pharmacological therapies. Nerve blocks, botulinum toxin, and intrathecal medications are adequately covered. The chapter by Mary Keenan and Patrick McDaid on orthopaedic interventions for the management of limb deformities in spasticity is the best chapter on this subject I have ever read and certainly should be compulsory reading for the physician who may need to refer to surgical colleagues for the management of complex and drug resistant spasticity.

    The problem with these early chapters is that they lack an overall strategic approach to the patient with spasticity. The editors have tried to correct this problem with the last four chapters in the book, which give individual views of the management of spasticity in children with cerebral palsy and in adults with multiple sclerosis, traumatic brain injury, and spinal cord injury. These are useful chapters that bring the rest of the book together, although there is some rather unavoidable repetition. A few illustrative case histories might have been useful in this section.

    Overall this is a thorough, reasonably comprehensive, well referenced, and up to date textbook, which can be recommended to the multidisciplinary spasticity team and is a useful reference for any neurologist.