Spasticity therapy reference (2026)

Spasticity therapy in 2026 organises around several layers, applied across underlying causes (post-stroke, multiple sclerosis, cerebral palsy, spinal cord injury, traumatic brain injury).

First-line: physiotherapy and occupational therapy with stretching, positioning, and functional training. Oral antispastic medicines (baclofen, tizanidine, dantrolene, diazepam) provide symptomatic relief but commonly cause sedation at doses needed for substantive effect.

Focal therapy: botulinum toxin injection (multiple approved formulations: onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, prabotulinumtoxinA) for focal or multifocal spasticity. Highly effective when delivered with appropriate selection and dosing.

Intrathecal therapy: intrathecal baclofen pump for severe generalised spasticity not responding to oral and focal options. Provides high baclofen dose to spinal cord with minimal sedation.

Procedural: selective dorsal rhizotomy in selected paediatric cerebral palsy patients. Orthopedic surgery for fixed contractures.

Emerging mechanism-targeted: myostatin pathway, alpha-adrenergic, and other novel mechanism programs are in late-stage trials with the proposition of efficacy without sedation.

The specialist-network and integrated-rehabilitation infrastructure bounds the addressable population for focal and intrathecal therapy. Botulinum toxin injection requires injector training and concentrated specialty services.