REMEDY : BNSSG referral pathways & Joint Formulary

Home > Formulary : Paediatric > Paediatric Chapters > 4. Nervous system >

BNSSG Paediatric Joint Formulary

4.3 Movement disorders

Last edited: 04-06-2024

4.3.1 Dystonias and other involuntary movements

First line drugs Second line drugs Specialist drugs Secondary care drugs


UHBW Paediatric Dystonia guideline



Trihexyphenidyl (TLS Amber)

Procyclidine (TLS Amber)

Other drugs used for dystonias:

Clonidine (TLS Amber)

Gabapentin (TLS Amber)

Baclofen (TLS Amber)

Haloperidol (TLS Amber)

Midazolam (TLS Amber)

Diazepam (TLS Amber)

Chloral hydrate (TLS Amber)

Clonidine patches (TLS Red)

  • For patients with secondary dystonia and dyskinesia, according to UHBristol treatment pathway for Medical management of dystonia


Dopamine precursors

Co-careldopa (Sinemet®) (TLS Amber)

  • For dopamine sensitive dystonia


Neurotoxins (Botulinum Toxins)

Botulinum toxin type A (Botox®, Dysport®, Xeomin®)

  • NICE TA260 Botox® for use in migraine (chronic)
  • Treatment of focal spasticity as per SPC

Botulinum toxin type B (Neurobloc®) (TLS Red)

  • Botulinum toxin preparations are not directly interchangeable
  • Botulinum toxin is not approved for treatment for hyperhidrosis. For this indication exceptional funding should be sought on a case by case basis
  • To minimise the risk of errors botulinum toxin should be prescribed by brand name.
  • Botulinum toxin type B is reserved for use in patients that have become tolerant to botulinum toxin type A



Ataluren (TLS Red)

  • NICE HST22 Ataluren for treating Duchenne muscular dystrophy with a nonsense mutation in the dystrophin gene (Specialist only)

Infliximab (TLS Red)