On first picking up this book, I was initially quite excited. It is well laid out and indexed, with beautiful high quality illustrations. This is backed up with access through the internet to a series of 22 videos showing various injection techniques. Glancing down the list of contents, in addition to all the old favourites, including hemifacial spasm, blepharospasm, and cervical and laryngeal dystonia, I was delighted to find sections on migraine, Frey's syndrome, palatal myoclonus, benign vocal fold disease and tracheoesophageal speech.

This book is written almost exclusively by US authors, with ‘guest appearances’ from Israel and Australia, and is strong on injection technique and backed up with excellent anatomical drawings.

However, as I delved deeper into the book looking for answers and ideas to help me in my practice in the UK, I became increasingly disappointed. I have found that commissioners here often refuse funding on the grounds that the treatment is ineffective. Consequently, I was hoping for well referenced sections on outcome measures. Unfortunately, there is no mention of even well known rating scales such as TWSTRS and USDRS.

The book is also very weak on diagnosis of movement disorders in the head and neck. I got the impression that the authors largely received patients into their practices ‘ready diagnosed’. There is little or no mention of the major diagnostic difficulties, such as how to tell the difference between essential tremor and dystonic tremor (with the exception of the larynx) or between organic disease and functional problems. Whilst various movement disorders are mentioned, there is no logical assessment process presented and discussed pertaining to diagnosis. The analysis of movements, however, is fairly well covered, enabling the clinician to choose which muscles to inject.

Other than switching brands of toxin, there is little discussion on management of the patient suspected of having antibodies to toxin.

To finish on an upbeat note, complications and pitfalls are dealt with and on the whole done well.

If you want a ‘how to do it’ book about Botox, then this is the book for you. If you want a book on how to start a movement disorder and botulinum toxin practice for head and neck conditions, then I would say that you are likely to be disappointed.