The spasticity service at NHNN offers a comprehensive, responsive multidisciplinary service to adults (over age 16) 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.
Dr Val Stevenson
National Hospital for Neurology and Neurosurgery
London, WC1N 3BG
Spasticity associated with any neurological condition.
Aftercare is provided by our spasticity nurse specialists.
Occasionally an individuals' spasticity cannot be managed sufﬁciently despite optimising posture, bladder and bowel function, skin integrity, stretching and exercise regimes, along with oral medication. In this situation an inpatient admission for further assessment is recommended; during this admission trials of intrathecal medication may be performed. Expand the heading below for details.
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 trial shows a beneﬁcial response and the team and patient are in agreement, then a baclofen pump will be implanted. 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 intrathecal baclofen pump clinic.
Phenol is 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 may be given - this will allow the patient and team to assess the effects before deﬁnitive treatment with phenol is considered.
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.