Spasticity management 

The spasticity service at NHNN offers a comprehensive, responsive multidisciplinary service to adults with spasticity associated with any neurological condition. Therapies provided include multidisciplinary assessments, video clinics, specialist physiotherapy, nurse-led telephone clinics, botulinum toxin and intrathecal therapies. Inpatient procedures including intrathecal phenol and baclofen (trials and pump implantation) are undertaken as necessary .

Conditions treated

Spasticity associated with any neurological condition.

Treatments

Occasionally an individuals' spasticity cannot be managed sufficiently despite optimising posture, bladder, bowel and skin regimes, stretching and exercise regimes and oral medication.  In this situation an inpatient admission for further assessment is recommended; during this admission trials of intrathecal medication may be performed.

Intrathecal Baclofen
Baclofen is a common drug given to treat spasticity, unfortunately when baclofen is taken in tablet form it may cause side effects.  In order to get the baclofen directly to the spinal cord it can be delivered by an implantable pump; this is placed in the abdomen and a catheter delivers the baclofen into the intrathecal space (the space around the spinal cord within the spine). This method uses much smaller amounts of baclofen to treat the spasticity, thus reducing any side effects.

If the trials show a beneficial response and the team and patient are in agreement, then a baclofen pump will be fitted.  It is important to remember that intrathecal baclofen treatment requires commitment from individuals during the trial and implant phase but also for its ongoing maintenance of regular refills and replacements.  Once an individual has a baclofen pump fitted, they will be regularly followed up in the weekly intrathecal baclofen pump clinic.

Intrathecal Phenol
Phenol is an a treatment which indiscriminately damages motor and sensory nerves - it is a treatment reserved for those individuals who do not have any functional movement in their legs, who have impaired sensation to their legs and who have impaired bladder and bowel function.

Before phenol is administered a trial of a long acting local anaesthetic drug is given - this will allow the patient and team to assess the effects before definitive treatment with phenol is considered.  Botulinum Toxin therapy
Botulinum toxin is the most widely used treatment for focal spasticity. The toxin is injected directly into the targeted muscle and blocks nerve transmission to the muscle.  Although the blockage is permanent, the clinical effect of injecting botulinum toxin is reversible due to nerve sprouting and muscle re-innervation leading to functional recovery of the muscle in a few months.

Botulinum toxin injections are done in conjunction with physiotherapy to obtain the maximum benefit.  The injections take 10 to 14 days to have a visible effect.

Patient aftercare

Aftercare is provided by our spasticity nurse specialists.

Dr Valerie Stevenson Neurology and neurosurgery, Spasticity management
Dr Rachel Farrell Neurology and neurosurgery, Spasticity management

 Contact details

Spasticity management
National Hospital for Neurology and Neurosurgery
Spasticity Assessment Clinic
Basil Samuel Outpatients
Queen Square
London, WC1N 3BG

Patient enquiries
Telephone: 020 3448 3561

GP enquiries
Telephone: 020 3448 3561
Fax: 020 3448 3711

Service manager - Dr Val Stevenson
Email: val.stevenson@uclh.nhs.uk

 Useful links


Patient leaflets