The 3rd edition of this book is a work of reference and guide for medical practitioners examining and treating spastic and dystonic movement disorders. The authors have chosen a highly practical approach and have included a large number of patients' photos to help memorise clinical conditions. In addition, numerous other fields of application have been developed for the drug botulinum toxin, e.g. urological, gastroenterological and gynaecological indications or pain (chronic migraine and other headaches, nerve compression syndromes). For this reason, this new edition has been supplemented by the new chapter "Vegetative Symptoms and Pain".

1.Spasticity141.1.Introduction141.2.Clinical Presentation191.2.1.Neurological Examination191.2.2.Additional Methods of Examination211.2.2.1.Reflex Measurement and Electromyography221.2.2.2.Imaging Methods231.2.2.3.Pedography and Kinematic Measurements241.2.2.4.Nerve Blocks251.2.3.Practical Procedures251.2.3.1.Clinical Examination251.2.3.2.Specific Clinical Tests for Documentation of Spasticity261.2.3.3.Documentation of Everyday Competence in spasticity261.2.4.Evaluation Scales for Spasticity and Effects261.2.5.Spastic Patterns of Posture and Movement271.3.Treatment281.3.1.General Facts281.3.1.1.Indication and Goals281.3.1.2.Planning the Therapy291.3.1.2.1.Treatment Modifiers301.3.1.2.2.Treatment Principles301.3.2.Pharmacological Treatment321.3.2.1.Systemic Oral Therapy321.3.2.1.1.Oral Drug Treatment331.3.2.1.2.Further Drugs351.3.2.2.Local Therapy361.3.2.2.1.Local Anaesthesia361.3.2.2.2.Alcohol, Phenol371.3.2.2.3.Botulinum Toxin (BoNT)371.3.2.3.Intrathecal Baclofen Therapy (ITB)501.3.3.Surgery521.3.3.1.Surgery of the Nervous System521.3.3.2.Surgery of the Musculoskeletal System531.3.4.Ortheses and Plaster Cast551.3.5.Physiotherapy and Occupational Therapy571.3.5.1.Physiotherapy571.3.5.2.Occupational Therapy581.4.Therapy of Special Clinical Presentations581.4.1.Upper Extremity581.4.1.1.Adduction and Internal Rotation of the Shoulder581.4.1.2.Elbow Spasticity611.4.1.3.Pronation and Supination of Forearm and Hand621.4.1.4.Spasticity of Wrist and Finger Muscles631.4.2.Lower Limb691.4.2.1.Equinus and Varus Foot691.4.2.2.Valgus Foot721.4.2.3.Extension of the Big Toe731.4.2.4.Spasticity of Knee Extensors731.4.2.5.Spasticity of Knee Flexors741.4.2.6.Spastic Flexion of the Hip761.4.2.7.Thigh Adductor Spasticity801.4.2.8.Toe Flexor Spasticity811.4.3.Further Clinical Pictures811.5.Special Therapy of Spasticity caused by Cerebral Palsy (CP) in Childhood and Adolescence852.Dystonia922.1.Introduction922.2.Definitions932.3.Clinical Classification942.3.1.Pathophysiological and Clinical Features942.3.2.Classification of Dystonia982.4.Diagnostics1012.4.1.Aetiologic Diagnostics1012.4.2.Phenomenological Diagnostics1022.5.Therapy1042.5.1.General Facts1042.5.2.Pharmacological Treatment of Dystonia1042.5.2.1.Systemic Therapy1042.5.2.1.1.Anticholinergics1052.5.2.1.2.Benzodiazepine1052.5.2.1.3.L-Dopa (with Decarboxylase Inhibitor)1062.5.2.1.4.Further Medication1062.5.2.2.Local Therapy (Botulinum Toxin)1072.5.2.3.Intrathecal Baclofen Therapy1072.5.3.Physiotherapy1072.5.4.Orthesis and Surgery1082.5.5.The Role of Psychotherapy1112.6.Therapy of Special Clinical Presentations1112.6.1.Generalised Dystonia1112.6.1.1.Idiopathic Torsion Dystonia Dystonia Musculorum Deformans1112.6.1.2.Myoclonic Dystonia1142.6.1.3.L-dopa-sensitive Dystonia1152.6.1.4.Paroxysmal Dystonic Syndromes1172.6.1.4.1.Paroxysmal Kinesiogenic Dystonia (Choreoathetosis) (PKD, [DYT10, DYT19] )1182.6.1.4.2.Paroxysmal Non-kinesiogenic Dystonia (Choreoathetosis) (PNKD [DYT8, DYT20])1182.6.1.4.3.Benign Infantile Paroxysmal Dyskinesia (Benign Paroxysmal Childhood Torticollis)1182.6.1.4.4.Paroxysmal Nocturnal (Hypogenic) Dystonia (Dyskinesia, PND)1182.6.2.Focal and Segmental Dystonia1192.6.2.1.Blepharospasm1202.6.2.1.1.Clinical Variations of Blepharospasms1222.6.2.1.2.Clinical Pictures Important for Differential Diagnosis1272.6.2.2.Dystonia of the Oropharyngeal / Laryngeal Area1382.6.2.2.1.Oromandibular Dystonia1382.6.2.3.Further Movement Disorders of the Oromandibular and Neighbouring Regions1442.6.2.3.1.Spasmodic Dysphonia1472.6.2.4.Cervical Dystonia and Dystonic Head Tremor The COL-CAP Concept1492.6.2.4.1.Special Diagnosis and Therapy of Cervical Dystonia in Childhood1802.6.2.5.Arm and Hand Dystonia1842.6.2.6.Leg and Foot Dystonia1932.6.2.7.Dystonia of Trunk Muscles1952.6.3.Botulinum Toxin in Tic Disorders1962.6.4.Drug-induced Dystonia1972.7.Dystonia and Trauma1983.Vegetative Symptoms and Pain2043.1.Introduction2043.2.Urological Indications2043.2.1.Neurogenic Detrusor Overactivity2043.2.2.Idiopathic Detrusor Hyperactivity2053.2.3.Interstitial Cystitis2053.2.4.Detrusor Sphincter Dyssynergia2053.2.5.Benign Prostatic Hyperplasia2053.2.6.Other Urological Indications2063.3.Gastroenterological and Gynaecological Indications2063.3.1.Achalasia2063.3.2.Diabetic Gastroparesis and Pyloric Stenosis2083.3.3.Sphinkter of Oddi Dysfunction2093.3.4.Anal Fissure2093.3.5.Other Proctological Indications2103.3.6.Obstructed Defaecation Syndrome (ODS)2103.4.Genital Indications2113.4.1.Pelvic Floor Dyssynergia: Vaginismus2113.4.2.Vulvodynia2123.4.3.Ejaculatio Praecox2123.4.4.Prophylaxis of Recurring Low-Flow Priapism2123.5.Pain2143.5.1.Chronic Migraine2143.5.2.Other Headaches2153.5.3.Nerve Compression Syndromes2163.5.3.1.Pronator Teres Syndrome2163.5.3.2.Posterior Interosseous Nerve Syndrome2173.5.3.3.Piriformis Syndrome2183.5.3.4.Neurogenic Thoracic Outlet Syndrome2223.5.4.Epicondylitis Radialis Humeri (Tennis Elbow) and Epicondylitis Ulnaris Humeri (Golfers Elbow)2243.5.5.Chronic Plantar Fasciitis (Heel Spur)2243.5.6.Morton Neuralgia2253.6.Glands2263.6.1.Axillary Hyperhidrosis2263.6.1.1.Frey's Syndrome2273.6.2.Other Hyperhidroses2273.6.3.Sialorrhea2283.6.4.Hyperlacrimation (Crocodile Tears)2303.6.5.Rhinorrhea2313.7.Diaphragmatic Myoclonus, Singultus2313.Appendix2353.1.Neuroanatomy of Muscles in Spasticity of the Extremities Guidance for Botulinum Toxin Therapy2353.2.Neuroanatomy of Neck Muscles in Cervical Dystonia2514.Further Literature260Index268