Adult Focal Spasticity Service

Welcome to the Adult Foca Spasticity Service where you can find information about management of patients with spasticity using botulinum toxin injections.

In this service we assess and treat adult patients with spasticity (muscle stiffness and/or abnormal limb positioning of neural origin) using botulinum Toxin (BoNT). Treatment may be indicated for patients with a diagnosis of stroke, traumatic brain injury, spinal cord injury, cerebral palsy, multiple sclerosis, dystonia and other neurological conditions. 

Who can refer to this service?
We accept refers from GPs, hospital physicians and therapists. 

Our Adult focal spasticity referral form is available here.

What will the clinic visit involve?

  • The clinic visit will involve a detailed multidisciplinary assessment by a consultant neurologist and a specialist physiotherapist.
  • During the first visit we will establish if treatment for spasticity is indicated and if BoNT injections is the right treatment.
  • When indicated, injections are commonly given during the same visit.
  • When appropriate, we provide advice and guidance on splinting, exercises and other matters to help maximise the benefit from the injections.
  • In most occasions, we will offer a follow-up appointment usually 3-4 months after the injections. Follow up appointments are usually with one of our senior trained physiotherapists.

Please remember:

  • We advise that the patient is accompanied by a relative or friend
  • We always welcome treating therapists to also attend, as it helps with the patient’s management.  

Important information about botulinum toxin injections:

  • BoNT injections usually take 4-10 days to take effect
  • Effects may last up to 3-4 months
  • Repeated injections (every 3 or 4 months) are needed in some cases to achieve the best effect and maintain it over time.
  • BoNT cannot be given to women during pregnancy or lactation.
  • BoNT is generally contraindicated in some neurological conditions causing muscle weakness, e.g. myasthenia gravis and motor neuron disease.
  • BoNT may interact with some medications, so a full list of medications should be provided when filling in the referral form 
  • If a patient is on anticoagulation, please make sure you provide details when filling in the referral form as we need to ensure in advance that the injections can be given safely.