Spasticity Services

About 80% of people with cerebral palsy (CP) and multiple sclerosis (MS) have varying degrees of spasticity. Other conditions that may cause spasticity include:

• Traumatic brain injury (TBI)
• Brain damage due to a lack of oxygen
• Stroke
• Encephalitis
• Meningitis
• Other neurological disorders

When injected into a muscle, botulinum toxin (Botox, Dysport or Myobloc) works by blocking the signal from a nerve that tells the muscle to tighten. When injected directly into a muscle group, it temporarily relaxes the muscle and allows it to stretch.

The procedure takes about 10 minutes. Injections are repeated every few months and may require several injections, depending on the area of treatment. If multiple areas are being treated, a child is often medically sedated to lessen the pain of numerous injections. A common side effect is tenderness at the injection site. Your child’s neurologist will discuss side effects with you and your child in more detail.

If needed, an oral sedative will be prescribed to be given by parents about one hour before the procedure. Your neurologist will clean the area to be treated with a topical antiseptic solution to prevent germs. Cold spray is applied immediately before the injection to numb the area. Buzzy®, a pain-relief vibrating device may also be used to help with discomfort during the injection.

A small needle is inserted into the targeted muscle and medication is injected. For muscles that are difficult to locate, a nerve stimulator is used to guarantee precise medication administration. Once complete, the patient will be sent home with detailed written instructions for home care.

Baclofen (also called Gablofen or Lioresal) is a skeletal muscle relaxant often used to treat increased muscle tone (hypertonia) and spasticity that is seen in children with cerebral palsy, multiple sclerosis, motor neuron disease or spinal cord damage. A baclofen pump is surgically implanted under the skin and consists of a pump and catheter. The pump has a reservoir that holds the baclofen medicine, while the catheter periodically delivers small amounts of baclofen into the spinal fluid. The rate at which the baclofen is released depends on how the pump is programmed by the provider.

After a baclofen pump is surgically placed, it is important to have a close follow-up with a trained provider as the reservoir will need to be refilled every few months. Furthermore, the dose of baclofen can be adjusted any time by a trained professional using a special wand and small computer that communicates with the pump.

Numbing cream will be applied around the area of the pump, so the child does not feel the needle stick. Parents may do this at home about one hour before the procedure. Your child’s neurologist will clean the area with a topical antiseptic solution to prevent germs, and a cold spray will be used to help numb the area.

A small needle will be inserted into the port of the pump. Your provider will empty any remaining medicine from the pump and refill it with the new medicine. Once complete, the pump is programmed to indicate a refill has been completed. The pump will also indicate when the next refill is due.

Side effects may include sleepiness, constipation, nausea, weakness, dizziness, blurred vision or changes in urination. In some children with epilepsy, it can cause an increase in seizures. Your neurologist can discuss possible side effects with you in more detail.