Spasticity is muscle stiffness and tightness caused by damage to the brain or spinal cord, as after a stroke, a brain or spinal cord injury, cerebral palsy or multiple sclerosis. It can cause pain, posture problems, difficulty with care and hygiene, and loss of function. Treatment ranges from therapy and tablets to injections, surgery on specific nerves, and a pump that delivers medicine directly into the spinal fluid.
Who it may help
- Stiff or painful limbs after stroke, cerebral palsy, spinal cord injury or brain injury
- Spasms that disturb sleep, sitting, walking or care
- Contractures, frequent falls or pressure sores
- Little benefit from tablets, physiotherapy or injections
- A recommendation for intrathecal therapy from a neurologist or rehabilitation physician
Conditions treated
- Cerebral palsy
- Post-stroke weakness and stiffness
- Spinal cord injury
- Multiple sclerosis
- Brain injury
- Mixed dystonia and rigidity
Treatment options
- Intrathecal baclofen pump A programmable pump placed under the skin of the abdomen delivers a small dose of baclofen directly into the spinal fluid, which is much smaller than the dose needed in tablets.
- Selective neurotomy Dividing part of the overactive nerves to specific muscles.
- Botulinum toxin injections Often tried first to relax individual muscles.
- Orthopaedic release Tendon lengthening, done together with orthopaedic and rehabilitation colleagues.
- A team approach Physiotherapy, orthoses and rehabilitation continue alongside any procedure.
Before the procedure
- Assessment of muscle tone with standard scales and of your functional goals
- A trial injection of baclofen into the spinal fluid to test the response, before a pump is implanted
- MRI or CT where needed
- A discussion with the rehabilitation team
- Counselling on pump care and refills
Recovery: what to expect
- Pump surgery: about 3 to 4 days in hospital.
- Neurotomy: usually 2 to 3 days.
- Pump programming begins about a week after surgery.
- Physiotherapy starts early so that relaxed muscles can be put to use.
- Refills and adjustments roughly every 3 to 6 months.
- Long-term monitoring of function and the device.
These are typical timings. Your own plan depends on your condition, your general health and the operation chosen, and Dr. Chakraborty will go through it with you.
Risks to know about
Every operation carries risk. The ones most relevant here are:
- Infection of the pump pocket or the spinal fluid
- Pump or catheter problems such as blockage or kinking
- Sudden stopping of baclofen, which can be dangerous and needs urgent attention
- Over-relaxation, with weakness or drowsiness if the dose is too high
- Leak of spinal fluid
Your own risks depend on your health and your scans, and are explained in detail before you decide on anything.
Common questions
Does it cure spasticity?
No. The aim is to reduce stiffness, improve comfort and make therapy and care easier.
How long does the pump last?
The battery usually lasts several years and the pump can then be replaced. The dose can be adjusted at any time.
Can children have this treatment?
Yes. Baclofen pumps and selective neurotomy are used in children with severe spasticity from cerebral palsy.
Will it replace physiotherapy?
No. It makes physiotherapy more effective by relaxing tight muscles.
This page is general information to help you prepare for a consultation. It is not medical advice and does not replace an examination. Every plan is made for the individual patient.