• Klinisk verifikation, som kan omfatte elektromyografisk undersøgelse på en specialafdeling, af toksinets virkning på den injicerede muskel/ de injicerede muskler. • Analyse af årsagerne til svigt, f. eks. dårlig udvælgelse af muskler til injektion, utilstrækkelig dosis, dårlig injektionsteknik, forekomst af fikseret kontraktur, antagonistmuskler for svage, dannelse af toksinneutraliserende antistoffer. • Revurdering af egnethed af behandling med botulinumtoksin type A. • Ved fravær af enhver form for uønskede virkninger sættes der sekundært til den første behandlingsseance endnu en behandlingsseance i gang som følger: i) justér dosis idet der tages hensyn til analysen af det tidligere behandlingssvigt; ii) brug EMG og; iii) oprethold et 3 måneders interval mellem de to behandlingsseancer.
All indications In case of treatment failure after the first treatment session, i. e. absence, at one month after injection, of significant clinical improvement from baseline, the following actions should be taken: • Clinical verification, which may include electromyographic examination in a specialist setting, of the action of the toxin on the injected muscle(s); • Analysis of the causes of failure, e. g. bad selection of muscles to be injected, insufficient dose, poor injection technique, appearance of fixed contracture, antagonist muscles too weak, formation of toxin-neutralising antibodies; • Re-evaluation of the appropriateness of treatment with botulinum toxin type A; • In the absence of any undesirable effects secondary to the first treatment session, instigate a second treatment session as following: i) adjust the dose, taking into account the analysis of the earlier treatment failure; ii) use EMG; and iii) maintain a three-month interval between the two treatment sessions.