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Neurological rehabilitation · UK

Spasticity management - oral medication, botulinum toxin, intrathecal pumps and physiotherapy.

Consultant rehabilitation medicine and neurology teams for spasticity after stroke, multiple sclerosis, cerebral palsy or spinal cord injury ’ oral baclofen, botulinum toxin injections, intrathecal baclofen pumps, physiotherapy and orthotics, joined up.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private spasticity management costs in the UK.

Indicative ranges across our partner units.

In short

£850–£1,600, home in 60 minutes.

Option Indicative range
Consultant rehab or neurology assessment £280–£500
Specialist neuro-physiotherapy assessment £150–£280
Botulinum toxin injection cycle (focal) £850–£1,600
Botulinum toxin injection cycle (multi-limb) £1,600–£2,800
Intrathecal baclofen trial £2,500–£4,000
Intrathecal baclofen pump implant £18,000–£28,000
Baclofen pump refill and review £350–£650

Prices vary by site, by complexity, and by whether add-on care is needed.

The problem

The right layer, the right team, and honest goals in your own words.

Spasticity care is where private clinics quietly under-deliver ’ single-modality thinking, no physiotherapy, and vague goals set for the notes rather than the patient.

  • Confirm the pattern

    Focal or generalised, active or passive, painful or functional ’ the pattern decides the treatment, not the diagnosis alone.

  • Pick the right layers

    Medication, injections, pump and physiotherapy work together. We layer, not swap.

  • Set goals in your words

    Every plan is built around a small number of goals you can measure ’ sleep, transfers, hand use, walking distance.

When it helps

When spasticity management is the right step.

The presentations we treat every week, and the red flag that means A&E, not a routine cycle.

  • Post-stroke spasticity

    A stiff arm or leg limiting dressing, transfers and hand use ’ classic indication for targeted botulinum toxin injections.

  • Multiple sclerosis spasticity

    Painful spasms, tight legs and difficulty walking ’ oral medication, botulinum toxin and sometimes an intrathecal pump.

  • Cerebral palsy spasticity

    Adults and children with CP ’ tight adductors, gastrocnemius or upper limb muscles limiting function.

  • Spinal cord injury

    Severe spasms limiting sleep, transfers or continence care ’ intrathecal baclofen is often transformative.

  • Traumatic brain injury

    Focal or generalised spasticity limiting recovery and rehabilitation ’ managed together with neurology and rehab.

  • Hereditary spastic paraparesis

    Progressive lower-limb spasticity ’ oral medication, focal injections and orthotics keep function stable.

  • Focal dystonia

    Cervical, blepharospasm or task-specific dystonia responds well to botulinum toxin.

  • Red flag: sudden neurological change

    New weakness, loss of bladder control or a sudden change is not a routine appointment ’ same-day neurology or A&E.

Procedure options

The approach depends on the pattern.

Focal spasticity, generalised spasticity and severe spinal spasticity each call for different combinations ’ here is how the options compare.

  • Oral antispastic medication

    Baclofen, tizanidine and gabapentin ’ useful for generalised spasticity but limited by drowsiness at higher doses.

  • Botulinum toxin injections

    Targeted injections into overactive muscles under ultrasound or EMG guidance ’ 3–4 month benefit per cycle.

  • Phenol nerve blocks

    A longer-lasting alternative for selected large muscles where botulinum toxin dose is limiting.

  • Intrathecal baclofen

    A pump implanted in the abdomen delivers small doses of baclofen straight to the spinal fluid ’ powerful for severe spasticity.

  • Selective dorsal rhizotomy

    A neurosurgical option in selected children with cerebral palsy ’ arranged through paediatric neurosurgery, not this service.

  • Specialist neuro-physiotherapy

    Stretch, standing, orthotic use and task practice ’ the essential companion to any injection or pump.

  • Orthotics and splinting

    Ankle-foot orthoses, wrist splints and lycra garments ’ prescribed alongside injections to prevent contracture.

  • Functional electrical stimulation

    Small stimulators worn on the leg to lift a dropped foot during walking ’ useful in stroke and MS.

Safety and recovery

What to expect from treatment - honestly.

Spasticity management is safe in specialist hands. The details that matter are muscle selection, physiotherapy alongside, and 24-hour access when a pump is involved.

  • Botulinum toxin

    Very safe when guided. Rare temporary weakness of injected or nearby muscles. Repeated cycles are well tolerated.

  • Oral medication

    Baclofen, tizanidine and gabapentin can cause drowsiness, weakness and dry mouth. Titrated carefully; abrupt withdrawal is avoided.

  • Intrathecal baclofen

    Very effective but needs specialist follow-up. Pump problems and catheter breaks are uncommon but serious ’ 24-hour team access is essential.

  • Baclofen withdrawal

    Missed refills or catheter failure can cause severe rebound spasticity, fever and delirium ’ treated as an emergency.

  • Injection site

    Brief soreness, mild bruising or a small haematoma at injection sites. Antibiotics are not routine.

  • Loss of useful spasticity

    Some patients rely on leg spasticity to stand or transfer. We aim to reduce, not abolish, tone in those cases.

  • Contracture

    Spasticity that has been present for years often leaves shortened muscles. Injections help but do not undo contracture ’ combined orthopaedic surgery may be needed.

  • Pregnancy

    Some antispastic medications and botulinum toxin need review before conception. Planned care with obstetrics.

  • Red flags after treatment

    New breathing difficulty, swallowing problems, severe headache after a pump refill, or a sudden increase in spasms needs the same-day team, not a routine call.

Reading your notes

Your notes in four parts. Read the last one first.

Whether it is a single focal cycle or a pump refill, the notes and plan keep to the same shape.

A UK consultant reviewing a patient’s notes

A quiet reminder

Neuro-rehab notes are precise ’ we translate them for you.

If you want us to walk you through the muscle map, medication changes and physiotherapy plan before your next cycle, just ask.

  1. 01 Header

    Session and team

    Date, consultant, physiotherapist, treatment given (medication change, injections, pump refill) and any next appointments.

  2. 02 Findings

    Muscles, tone and goals

    Muscle groups treated, tone scores, active and passive range of movement, and goals agreed with you.

  3. 03 Progress

    Change between cycles

    What has changed since the last cycle ’ pain, spasm frequency, function, ease of care.

  4. 04 Impression

    Next cycle and plan

    Read this first: next injection date, medication changes, physiotherapy plan and any onward referral.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Medically indicated spasticity treatment is covered by many policies. Pumps are covered by higher-tier policies and case-by-case.

Frequently asked

Everything we get asked about spasticity management.

Quick answers on cost, botulinum toxin, pumps, physiotherapy and NHS context.

  • How much does private spasticity management cost in the UK?

    A focal botulinum toxin injection cycle typically costs £850–£1,600 in 2026, multi-limb injections £1,600–£2,800, and an intrathecal baclofen pump implant £18,000–£28,000. Refills, physiotherapy and orthotics are billed separately.

  • Does botulinum toxin actually work?

    For focal upper motor neuron spasticity, yes ’ a strong evidence base and NICE support. Best results come from careful muscle selection, ultrasound or EMG guidance and physiotherapy alongside.

  • How often do I need botulinum toxin?

    The effect lasts 12–16 weeks. Most people have three or four cycles a year. Some settle into a longer interval as physiotherapy and orthotics take over.

  • When is an intrathecal baclofen pump the right choice?

    For severe, generalised spasticity ’ especially after spinal cord injury or in progressive MS ’ where oral medication and injections have not been enough. A pre-implant trial confirms benefit before surgery.

  • What role does physiotherapy play?

    Central. Injections and pumps create a window ’ physiotherapy uses it to stretch, stand, walk and retrain. Without physiotherapy, injection benefit is often lost.

  • Does the NHS offer this, and why go private?

    Yes ’ regional NHS spasticity services deliver botulinum toxin, physiotherapy and, in specialist centres, intrathecal baclofen. Private routes are used for speed, choice of consultant, longer appointments and joined-up delivery in one clinic.

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