This is a reminder that the FHFT Adult Focal Spasticity Service assesses and treats adult patients with focal spasticity using Botulinum toxin (BoNT) as per the RCP National Guidelines 2018: ‘Spasticity in adults: management using botulinum toxin’ 
 
The spasticity clinics are held weekly at both Frimley Park Hospital and Wexham Park Hospital. Appointments involve an assessment by a specialist doctor and neuro-therapist (either physio or OT). 
 
During the first visit we establish if treatment for spasticity is indicated and if BoNT injections are appropriate. When indicated, injections are usually given during the same visit. 
 
We also provide advice and guidance on splinting, exercises, and other matters to help maximise the benefit from the injections and will refer to other services if required. Usually, one of the therapists will follow up at 4-6 weeks (peak BoNT effect) either by phone call or in person. 
 
Please refer to the below services on eRS. If you need any advice prior to referring or if you are unsure that this is the right service for the patient, please use the advice and guidance service available on eRS.

eRS and directory of service details 
Speciality  Clinic type Service name  Location A&G
Neurology  Stroke (not TIA)  Stroke - Known Patient - Frimley Health - RDU01  Frimley Yes
Stroke - Known Patient - Frimley Health - RD7 Wexham

 

Inclusion and exclusion criteria for the FHFT Adult Focal Spasticity Service - using Botulinum toxin (BoNT) (as detailed in the eRS Directory of Service (DoS). 

Appropriate (inclusion criteria): 

  • Age 16 and above  
  • Treatment may be indicated for patients with a diagnosis of stroke, traumatic brain injury, spinal cord injury, cerebral palsy, multiple sclerosis, and other neurological conditions causing upper motor neurone (UMN) injury.  

 

 Inappropriate (exclusion criteria): 

  • We are unable to offer generalised spasticity management i.e. if the spasticity is not focal and the ongoing management of oral medication is required. 
  • If a patient is taking Warfarin, we shall be requesting that they have an INR within 48 hours of the appointment as we are unable to inject if the INR is greater than 2.9. 
  • 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. 
  • BoNT contains human blood products and therefore may not be acceptable to a Jehovah's Witness. 

For any questions regarding the service please email: fhft.spasticityclinic@nhs.net 

Dr Fiona Song - Associate Specialist in Neurorehabilitation, Stroke Unit, Frimley Park Hospital