Here you will find the recommendations we have made about the use of individual medicines in Lancashire.

Botulinum Toxin Type A

Brand: All brands within licensed indications only
Indication: Contracture of the joint in multiple sclerosis
Disease category: Central nervous system
Commissioning responsibility: CCG
PbR excluded: Yes


NICE CG186 does not make a recommendation on use of botulinum toxin A for contracture of the joint in MS and states that problems are ‘complex and need individual assessment. Botulinum injection along with prolonged stretching modalities using serial plaster casts, standing frames or removable splints, has been approved locally after a review of audit data, provided
• treatment is restricted to those patients who have failed or could not have other treatments
• treatment is only initiated by an appropriate specialist with experience in use of botulinum toxin A, that there are clearly defined goals of treatment — set prior to initiation and against which patients will be reviewed at each injection cycle.


LMMG recommendation: Red
Click here to find the definitions for the colour classifications

Reason for decision:  Specialist medicine

Supporting documents:


Decisions of Lancashire local decision making groups:

NHS Blackburn With Darwen CCG and NHS East Lancashire CCG NHS Blackpool CCG NHS Chorley and South Ribble CCG and NHS Greater Preston CCG NHS Fylde and Wyre CCG NHS Morecambe Bay CCG NHS West Lancashire CCG