BOOK R EV IEWS
Book Reviews
MOVEMENT DISORDERS IN CHILDREN
(International Review of Child Neurology Series.)
Edited by Emilio Fernandez-Alvarez and Jean Aicardi.
263 pp., illustrated. London, Mac Keith Press, 2001. $74.95.
ISBN 1-898-68323-9.
T HE term “movement disorders” refers to a heteroge-
neous group of neurologic conditions that share the
clinical presentation of involuntary movements and that
are presumed to arise from pathophysiologic abnormalities
in the basal ganglia or extrapyramidal motor system. Most
of these conditions are rare, but a few, such as tic disorders,
are quite common. Our understanding of the basic science
underlying these disorders is rapidly increasing, thanks to
the use of functional magnetic resonance imaging, positron
emission tomography, and single-photon-emission comput-
ed tomography, along with advances in molecular genetics.
Tools for clinical diagnosis and strategies for treatment, how-
ever, have lagged far behind knowledge about the underpin-
nings of the disorders.
Movement Disorders in Children is part of the Interna-
tional Review of Child Neurology Series published for the
International Child Neurology Association. The two well-
qualified authors and a number of contributors provide an
up-to-date review of the literature and a structured approach
to understanding these disorders. Each chapter is devoted to
a group of disorders defined by the nature of the movements
involved. This approach is useful, given the reasonable un-
derlying assumption that the disorders in each group share
some pathophysiological features and may therefore be amel-
iorated with the use of similar treatment strategies. The pri-
mary movement disorders, each of which is covered in a
chapter of its own, include those in which the predominant
feature is the hypokinetic–rigid syndrome, tremor, chorea or
ballismus, dystonia or athetosis, myoclonus, or tics. Other
chapters discuss diseases in which the presenting symptom
is a mixed pattern of abnormal movements, diseases associat-
ed with paroxysmal movements, and secondary conditions
such as drug-induced movement disorders and those that
occur as part of cerebral palsy.
An introductory chapter briefly but adequately reviews
the functional organization of the basal ganglia, the patho-
physiology of movement disorders, and basic issues related
to clinical diagnosis, demographics, and classification. The fi-
nal chapter provides limited discussion of ancillary investiga-
tions, including electrophysiological studies, imaging stud-
ies, and tissue biopsies.
The book does not include an integrated discussion of
the genetics of movement disorders. Although relevant in-
formation is provided in the discussion of each disorder, the
advances that are currently being made in the area of mo-
lecular genetics are important enough to merit a comprehen-
sive discussion in this book. Newly acquired genetic infor-
mation not only is beginning to change our understanding
of individual movement disorders, but is also defining new
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approaches to diagnosis and treatment. It is clear that the
current nosology will have to be substantially modified
on the basis of the genetic abnormalities underlying these
conditions.
The preface notes that the book is geared toward clinically
oriented neurologists and pediatricians. Despite its small size,
this book will be a valuable reference source for specialists.
It provides a comprehensive catalogue of movement disor-
ders, including some that are exceedingly rare. The basic or-
ganization of the material is good, and the format of the
book allows the reader to find the appropriate references eas-
ily; these references range from classic articles to those that
are as recent as one could reasonably expect, given the usual
interval between the completion of the manuscript and the
distribution of the book.
Nonspecialists may find this book interesting to read,
but it will be less useful for primary care pediatricians, who
probably have little experience in the diagnosis and treat-
ment of these disorders. The usefulness of the book would
have been greatly enhanced by the inclusion of more tables
and algorithms to assist clinicians in defining the abnormal
movements they observe and in working their way toward
the most likely diagnosis. For example, the chapter on chorea
and ballismus presents a full-page table classifying the cho-
reas but provides little guidance in the differential diagnosis.
The chapter on dystonia and athetosis, on the other hand,
has a number of useful tables and provides a much more
structured and useful approach to diagnosis and manage-
ment. It appears that the authors, in an attempt to be com-
prehensive, give equal weight to all of the literature reviewed
and do not attempt to distill the information and present
it in a form that would be useful to a nonexpert who en-
counters a patient with involuntary movements. Although
the majority of such patients are referred to specialists, more
guidance for primary care practitioners would result in more
appropriate referrals.
One problem with all books on movement disorders is
the difficulty involved in describing movements in words or
in illustrating them with photographs. This book, and all
others in this area of neurology, would be greatly enhanced
if future editions could be accompanied by a videotape, CD,
or DVD illustrating the defining characteristics of the move-
ment disorders.
GERALD GOLDEN, M.D.
2301 Cherry St. Apt 8F
Philadelphia, PA 19103
ggolden@alumni.princeton.edu
TOUCH
By Tiffany Field. 181 pp., illustrated. Cambridge, Mass.,
MIT Press, 2001. $22.95. ISBN 0-262-06216-X.
F EW physicians talk about the clinical use of touch, and
few medical schools teach it specifically, even though
touch is a unique tool for diagnosis and therapeutic appli-
cations, as well as a means of communicating a caring at-
titude. In the poem “Line Drive,” by Allen Ginsberg, the
 The Ne w E n g l a nd Jo u r n a l o f Me d ic i ne
physician realizes that he “forgot to touch or be touched”
while giving bad news to a patient. This line reminds us that
touch includes not only physical touch but also emotional
and compassionate possibilities as one person’s experience
affects another’s. But contemporary medicine, in part be-
cause of time constraints and sophisticated diagnostic inter-
ventions, often limits the use of touch in patient care. The
public has noticed this change, as suggested by the title of a
recent New York Times article: “Are Doctors Losing Touch
with Hands-on Medicine?” Medical educators and practic-
ing physicians can learn from our colleagues who are experts
in using touch and associated therapies.
In this book, Field, director of the Touch Research In-
stitutes at the University of Miami School of Medicine, ar-
gues that Western society, including the medical profession,
marginalizes and minimizes the importance of touch. She
reviews many factors, such as concerns about sexual harass-
ment, legal repercussions, and an aging population, that
diminish the use of touch in general. Calling America a
“touch-taboo” society, Field questions the restrictions placed
on touch. One example of an area in which the trend is to
limit touching is education: legal restrictions and fear of
lawsuits restrict a teacher’s ability to comfort a child.
Touch is a sensation that not only helps us understand
our environment but also connects us to others. Field cites
the pioneering work of Ashley Montagu in Touching: The
Human Significance of the Skin (2nd ed., New York: Harper
and Row, 1978) and Harry Harlow’s research at the Univer-
sity of Wisconsin during the 1950s. Harlow’s experiments
with infant monkeys and surrogate mothers demonstrated
that the infants “preferred the cloth mother without milk
over the wire mother with milk” — observations that sug-
gested the importance of touch stimulation in early life.
In the initial chapters of her book, Field reviews the tra-
ditions of touching in many cultures from sociological and
anthropologic perspectives. She also examines the effect of
touch on growth and development, the effect of therapeutic
massage on the progression of various illnesses, and the use-
fulness of massage in maintaining health and preventing dis-
ease. Field explores these and other topics as she reports on
research involving infants, children, adolescents, and adults,
most of it sponsored by the Touch Research Institutes. Com-
mitted to both the use of touch in health care and other
settings and to the scientific exploration of touch, Field of-
fers this book as her attempt to help bring touch into the
mainstream of our lives.
Touch offers information to readers with scientific back-
grounds and those with general interests in touch and related
therapies. There are, for example, concise, informative re-
views of the skin and its neurologic connections and of ther-
apies that involve touch. These presentations are clear and
concise, but they are not a comprehensive or detailed review
of the topics.
I had several concerns as I read this book. One is the em-
phasis on Field’s own research. She may be a leader in the
field, but there are other investigators whose contributions
are not mentioned.
In addition, the outcomes (e.g., weight in infants, sleep
habits, and levels of anxiety) of touch interventions, usually
massage, and physiological measurements (e.g., cortisol lev-
els) after the use of such interventions, are presented without
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a description of the details of the study. The quality and va-
lidity of such findings cannot be assessed without consid-
eration of the study design and methods used. Critical read-
ers will have questions about many of the reported outcomes
of touch interventions, and conclusions based on evidence
cannot be made from reading this book. On the other hand,
to report all the details of the studies would result in a dif-
ferent book. Field appears to be addressing a broad audience:
experts in touch therapies, persons interested in expanding
the use of touch interventions in health care and other set-
tings, and health care professionals in general. In the absence
of information about the study design and methods, read-
ers need to use caution in accepting (or rejecting) study out-
comes. References are provided for readers who want to take
a closer look, and most of the cited articles are in accessible
journals.
Field’s conclusions, contained in a single paragraph em-
bedded in the last chapter of her book, unfortunately do
not further the direction of research, provide ideas for cur-
ricular innovations at schools for health care professionals,
or indicate specific recommendations for the integration of
touch therapies in our society. Field’s book provides a review
of the historical and cultural research on touch, an over-
view of touch therapies, and a summary of contemporary
topics of research. The outcomes of much of the research
remain in question because of the author’s reporting style.
Experts in touch therapy will see this book as a review of
their field, and some may feel excluded, whereas persons
who are interested in beginning research on touch or inte-
grating touch therapy into everyday practice may be pleased
with this book as an introduction to the topic. They will
need to draw their own conclusions about the effect of mas-
sage and other touch therapies used in various settings.
JULIA E. CONNELLY, M.D.
University of Virginia School of Medicine
Charlottesville, VA 22908
jec8k@virginia.edu
Book Reviews Copyright © 2002 Massachusetts Medical Society.
B OOKS R ECEIVED
The receipt of these books is acknowledged, and this listing must be regarded
as sufficient return for the courtesy of the sender. Books that appear to be
of particular interest will be reviewed as space permits. The Journal does
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ANESTHESIA AND CRITICAL CARE
Anaesthesia, Pain, Intensive Care and Emergency Medicine. Edited
by Antonio Gullo. 973 pp., illustrated. New York, Springer-Verlag,
2001. $85.95. ISBN 88-470-0136-6.
The Clinical Practice of Emergency Medicine. Third edition. Edited
by Ann Harwood-Nuss, with Allan B. Wolfson, Christopher H. Lin-
den, Suzanne Moore Shepherd, and Phyllis Hendry Stenklyft.
1827 pp., illustrated. Philadelphia, Lippincott Williams & Wilkins,
2000. $199. ISBN 0-7817-1680-2.
Handbook of Clinical Anesthesia. Fourth edition. Edited by Paul G.
Barash, Bruce F. Cullen, and Robert K. Stoelting. 964 pp., illustrat-