Botulinum toxin injections during the COVID-19 epidemic: A retrospective chart review

BACKGROUND AND AIM: Clinical services were severely affected globally during the COVID-19 pandemic. This study aimed to characterize the clinical experience of using botulinum toxin (BTX) injections during the COVID-19 pandemic. Method(s): This is a retrospective chart review of patients who received BTX injections from April 2019 to January 2022. Result(s): A total of 105 patients received an BTX injections, out of which 76 (72.4%) were men. The mean age of the patients was 47.9 +/- 15.1 years. The most common indication for receiving BTX injections was dystonia (n = 79;75.2%), followed by hemifacial spasm (n = 22;21%) and miscellaneous movement disorders (n = 4;3.8%). Focal dystonia (n = 45;57%) was the most frequent form of dystonia, followed by segmental dystonia (n = 24;30%). The percentage of generalized dystonia and hemidystonia was 12% and 1%, respectively. Cervical dystonia (44.4%), blepharospasm (17.8%), and writer's cramp (15.6%) were the most frequent forms of focal dystonia. The miscellaneous group included four patients (3.8%) with trigeminal neuralgia, Holmes tremor, dystonic tics, and hemimasticatory spasm. The mean ages of patients in the dystonia, hemifacial spasm, and the miscellaneous groups were 47.7 +/- 14.9 years, 49.2 +/- 14.0 years, and 44.2 +/- 26.0 years, respectively. The mean BTX dose was 131.6 +/- 104.1 U. The mean BTX doses for the dystonia group, hemifacial spasm, and the miscellaneous group were 158.7 +/- 105.3 U, 40.1 +/- 11.3 U, and 100.0 +/- 70.7 U, respectively. Conclusion(s): Most patients in our cohort had dystonia, followed by hemifacial spasm. Among the patients with dystonia, most had focal dystonia, with cervical dystonia being the most common movement disorder. The data obtained in our study is important to increase awareness of the effectiveness of BTX injections in patients with chronic disorders.Copyright © 2023 Annals of Movement Disorders.

Functional movement disorders during the COVID-19 pandemic

Functional movement disorders (FMDs) are a heterogenous group of movement abnormalities that greatly affect the quality of life of patients. They usually manifest as a result of underlying psychological or psychiatric illnesses without any known structural or neurochemical diseases. Various neurological disorders such as encephalitis, stroke, demyelination, seizures, and neuropathy have been reported by otherwise healthy individuals during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Here, we describe the case of a 27-year-old woman who presented to our outpatient department with episodes of deviation of angle of mouth with variability and distractibility. Following thorough clinical evaluation and appropriate investigation, the underlying etiology was identified as FMD secondary to the restrictions imposed during the COVID-19 pandemic to contain the transmission of the virus. The lockdown, isolation, financial strain, and other pandemic-related issues are stressors that may contribute to psychogenic disorders in people.Copyright © 2021 Annals of Movement Disorders Published by Wolters Kluwer - Medknow.

Hyperkinetic movement disorder following Covid-19 Temporal correlation or Coincidental

Objective: Hypokinetic movement disorder and parkinsonian picture has been well described in literature following covid-19 but hyperkinetic MDS are very in global literatures. To investigate the epidemiology,clinical picture,the diagnostic and therapeutic challenges in patients hyperkinetic MDS in this context and to know the time schedule of the onset of the MDS with exploring the possible pathogenesis Background: Infections are up to 20% of movement disorders.The most frequent agents are beta-hemolytic streptococcus,and flavivirus causing Japanese encephalitisThe role of the viral stimulation of microglial activation in neuroinflammation has regained attention in the context of covid19 Methods: Patients of MDS attended the clinic from 31st march 2020 to March 2022,with recent onset of hyperkinetic movements were screened. Subjects had medical history either prior to the study or medical history reviewed by physicians suggestive of covid.PCR +VE or Presence of covid antibody in blood or csf in patients with recent onset hyperkinetic MDS within 6-12 weeks of onset of symptoms except.Ventilatory cases Other markers were used to rule out other viral infections causing MDS.MRI brain and EEG as a routine in all Immune markers in very selected cases in suspected immuomediated MDSThe attempted treatment were symptomatic and immunotherapy Results: In last 2 years 50 cases of new onset Hyperkinetic MDS are recorded, out of which only 9 cases were directly or indirectly linked to Covid,Nystagmus, orofacial dyskinesia and segmental or generalized myoclonus and ataxic gait associated delirium,tremors and ocular movement disorders along with epileptic seizures are also seen.Positive EEG findings are in the form of diffused bihemispheric slowing or periodic complexes with polyspikes at irregular interval and delta brush in few cases .MRI findings varied between non-specific changes to bitemporoparietal hyperintensities in flair and T2 both cortical and subcortical or bilateral basal ganglia. Treatment response in all the cases are statisfactory Conclusion(s): observational study revealed MDS in covid do happen Myoclonus is the most Frequent movement disorder associated with COVID-19 followed by dystonia and tremors .pathophysiology included neuro inflammation, autoimmune mechanisms and small vessels thrombosis hence not be co-incidental , response to steroid also s/o immune mediated.

Status dystonicus in a patient with cerebral palsy and COVID-19.

Introduction: status dystonicus (SD) is a rare condition characterized by generalized and intense exacerbation of muscle contractions. Objective(s): to present a pediatric patient with SD associated with COVID-19. Case report: 3-year old male with cerebral palsy. He was admitted to the emergency room after four days with respiratory symptoms, which were accompanied by increased muscle tone, generalized dystonia, and febrile seizures. In laboratory tests, COVID-19 was confirmed, as well as an elevation of creatine phosphokinase (CPK), 16,000 U/L. Diagnosis of SD is established, recovering after receiving medical management. Conclusion(s): SD can cause serious complications, so it is essential to identify possible triggers in patients with greater susceptibility.Copyright © 2022 Authors. All rights reserved.

Ambulatory Botulinum Neurotoxin Injections for Dystonia, Spasticity, and Hemifacial Spasms: Predictors of Adherence a Year Before, During, and Late Covid-19 Pandemic

Objective: The relevance of the study is to primarily determine the predictors of adherence (distance, socio-economic status, disease status, and treatment schedule) of patients with dystonia, spasticity, and hemifacial spasms in a single center Botulinum neurotoxin injection (BoNT) study. Background(s): In December 2019, there was a new type of coronavirus identified in Wuhan, China which rapidly escalated to all parts of the world, the Philippines included. The COVID 19 pandemic did not only affect the patients contracted with the disease, but also those who have non-communicable diseases including dystonia, spasticity, and hemifacial spasm. BoNT is a chemodenervating agent that reduces muscle hyperactivity and spasms. Continuation of outpatient treatment may be affected due to the following reasons: lack of access to the health care system because of travel restrictions or lockdowns;fear of contracting the virus;and finances, which has a bigger impact on lower income patients. Method(s): This study utilized a cross-sectional research design with a total of 120 samples. Inclusion and exclusion criteria were met. Consent was secured. Data was gathered through chart reviews, telecommunications, and evaluation after receiving BoNT treatment in three different timelines-a year before (March 1, 2019 to February 29, 2020), during (March 1, 2020 to February 28, 2021), and late COVID 19 pandemic (March 1, 2021 to February 28, 2022). Result(s): The result of this study using percentages and p-values demonstrated a higher percentage in the distance and socio-economic status, as well as in the lost to follow up rate when compared to the other group. Distance and patients lost to follow up had p-values of less than 0.05. Therefore, only distance was noted to be a significant factor to the adherence status of patients. Furthermore, the lost to follow up rate in the COVID 19 pandemic period is also significantly higher when compared to that of the other group. Conclusion(s): It is concluded that patients with closer distance to the facility had better adherence hence the researchers recommend having an affiliate clinic or a referral facility for patients residing outside Metro Manila for better adherence.

Hyperkinetic movement disorders following SARS-CoV-2 infection and vaccination - an update.

The aim of this review was to summarise current knowledge regarding hyperkinetic movement disorders related to SARS-CoV-2 infection and vaccination in terms of phenomenology, epidemiology, pathogenesis and treatment. After a thorough review of the PubMed and Google Scholar databases (2020-2022), we identified myoclonus and ataxia sometimes accompanied by opsoclonus (AMS) as the two most frequent COVID-19 sequelae, with chorea, tremor and dystonia being very rare. The pathogenesis seems to be variable, but in the majority of AMS cases it was autoimmunological, with good response and recovery after corticosteroids or intravenous immunoglobulins infusions. Vaccination may be complicated by hyperkinetic movement disorders (e.g. tremor, dystonia), but this is very rare. Patients with Deep Brain Simulation depletion should not be postponed due to lockdowns as this may result in fatal outcomes.

Incidence and characteristics of post-COVID-19 parkinsonism and dyskinesia related to COVID-19 vaccines.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an infectious disease mainly affecting the respiratory system; however, a significant prevalence of neurological symptoms has been noted. OBJECTIVES: To investigate the incidence and characteristics of post-COVID-19 parkinsonism and to study dyskinesia related to COVID-19 vaccines. MATERIAL AND METHODS: The MEDLINE, PubMed, Scopus, and Web of Science databases were searched for all manuscripts relevant to post-COVID-19 parkinsonism and dyskinesia related to COVID-19 vaccines. Subsequently, we extracted and analysed data from the manuscripts in a structured manner. RESULTS: We found 24 patients with post-COVID-19 parkinsonism, with a mean onset age of 58 years after a mean of 30 days from the COVID-19 onset. Akinetic-rigid (n = 11) and mixed (n = 6) subtypes were the most common. Asymmetry was present in 13/15 patients. Brain MRI was unremarkable in 11/19, whereas dopaminergic system imaging was abnormal in 8/8 patients. Responsiveness to dopaminergic treatment was observed in 12/15 patients. Four patients improved after immunomodulatory therapy. Comorbidities were present in 9/24, encephalopathy symptoms in 11/24, and loss of smell in 9/13 patients. Most patients (n = 14) suffered serious COVID-19- related complications and three were treated with haloperidol. Parkinsonism improved (n = 5) or resolved (n = 4) during the follow-up. Five patients, with a mean age of 52, developed dyskinesia at a mean of 25 hours after receiving the COVID-19 mRNA vaccines. One patient had a history of neuropsychiatric symptoms and developed functional dyskinesia of the tongue. Four patients had a previous history of Parkinson's Disease (PD) with a mean duration of 10 years and developed dyskinesia and dystonia, which resolved (n = 2) or improved (n = 2) during the follow-up. CONCLUSIONS: Post-COVID-19 parkinsonism is a very rare complication, and it is likely that this is an umbrella syndrome that includes many different etiologies. Dyskinesia due to COVID-19 vaccines is exceedingly rare and probably has the same pathophysiological basis as in other conditions with exacerbation of PD symptoms.

Acute cervical dystonia following the BNT162b2 mRNA COVID-19 vaccine.

The coronavirus disease of 2019 (COVID-19) pandemic is caused by a novel coronavirus SARS-Cov-2. Four major vaccine types are being used to fight against this deadly pandemic and save precious human lives. All types of vaccines have been associated with a risk of neurological complications ranging from mild to severe. Cervical dystonia occurring after a COVID-19 vaccine was not previously reported in the literature. In this article, we describe a case of acute cervical dystonia occurring after the first dose of the BNT162b2 COVID-19 vaccine. We attribute the occurrence of cervical dystonia to the vaccine due to the temporal relationship. This report adds to the literature a possible rare side effect of a COVID-19 vaccine and contributes to the limited literature on potential neurological side effects of mRNA-based vaccines. The likely mechanism is autoimmune. Further research is needed to probe and study the exact mechanism.

Blepharospasm as a tardive manifestation of COVID-19 disease: A case report.

We report three cases of blepharospasms developed after a symptomatic COVID-19 infection, in order to describe a possible association between COVID-19 infection and essential blepharospasm. Blepharospasm could represent a late sign of COVID-19 infection (more than four weeks after the contagion) and may be triggered by the neurotropism of the coronavirus.

Clinical Improvement Following Delayed Initiation of Immunotherapy in a Case of LGI1 Antibody Encephalitis Presenting with Faciobrachial Dystonic Seizures Following COVID-19 Vaccination

Objective To demonstrate a case of suspected post-vaccine autoimmune encephalitis associated with leucine-rich glioma-inactivated protein (LGI1) antibodies with significant clinical improvement after initiation of immunotherapy nearly a year after symptom onset. Background Although the autoimmune encephalitides have overlap in presentation, some have unique manifestations (such as orofacial dyskinesias seen with NMDA encephalitis). These unique associations can serve as a clinical marker of response to treatment and even allow for earlier initiation of immunotherapy while awaiting results from antibody testing. LGI1 encephalitis characteristically presents with faciobrachial dystonic seizures (FBDS) that are refractory to anti-seizure medications (ASMs) but responsive to immunotherapy. Design/Methods Case report Results A previously healthy and highly independent 89-year-old woman developed what she described as abnormal posturing and spasms of the right shoulder two to three weeks after receiving the J&J COVID-19 vaccine. The abnormal movements progressed to involve the right side of her face and were refractory to multiple ASMs. EEG captured multiple events without epileptiform correlate. Several months later she developed paranoia, delusions, and hallucinations. Autoimmune encephalopathy panel returned positive for the LGI1-antibody around nine months after the onset of FBDS. Upon our initial exam, she had a fluctuating level of arousal, impaired recall of recent events, and was tangential in conversation. There were frequent, brief, repetitive, dystonic movements of the right side of the face consistent with FBDS. Admission was arranged for immunotherapy (intravenous methylprednisolone and intravenous immunoglobulin). Upon follow-up four weeks later, there was significant improvement in arousal and concentration with resolution of FBDS and delusions. Conclusions This case highlights a classic case of LGI1 encephalitis after vaccination presenting with FBDS and progressive cognitive changes. Despite immunotherapy being delayed, there was marked clinical improvement. It is important to recognize this entity and that it typically has a favorable outcome.

Needs and Perceptions of Patients With Dystonia During the COVID-19 Pandemic: A Qualitative Framework Analysis of Survey Responses From Italy.

Introduction: The COVID-19 pandemic and its countermeasures have created changes in both life and healthcare. With the prioritization of COVID-19-related management, the risks and experiences of patients suffering from rare conditions, such as dystonia, during the pandemic remain understudied. Materials and Methods: Using a framework analysis of a nationwide qualitative online survey, we sought to explore the perspectives of patients with dystonia on their clinical assistance and possible unmet needs during the first pandemic wave. An online survey consisting of 37 items (such as demographic characteristics, dystonia-related features, neurological service provision, therapeutic relationship with the neurologist, perceptions related to virus infection, perceptions about healthcare-related needs, work-related questions, requesting information, and seeking support during the pandemic) was carried out using both close and open-ended questions. Results: Responses from 62 participants were collected, with most of them from the red zones in Italy, where they were confined indoors. Social isolation was a relevant stressor. Motor and non-motor symptoms increased with detrimental consequences for patients' job and daily functionality. Outpatient clinics and rehabilitation sessions were temporarily shut down, and even telephone/mail support was sparse. Despite efforts, patients felt alone in dealing with dystonia. Conclusion: The first wave of the pandemic and its related restrictions had detrimental consequences for people living with dystonia, and their relevant needs remained unmet. These findings may contribute to implementing remedial healthcare provisions in this pandemic or in future pandemics.

Management of movement disorders in primary care

Movement disorders (MDs), are a spectrum of neurological diseases consisting of motor and non-motor symptoms regarding the dysfunctional motor control circuitry and some parts of the nervous system including the basal ganglia, thalamus, cortex, cerebellum besides peripheral autonomic nervous system. Usually, movement disorders are a clinical syndrome which is a specific movement disorder with some other disorders besides neurological and non-neurological abnormalities. The clinical manifestations that should be considered as MDs are complex and heterogeneous. These conditions include symptoms of motor functions like tremor, myoclonus or dystonia, so-called hyperkinetic movements, problems with cognitive functioning like attention problems, prediction error, and sometimes emotion hyper-responsiveness. It is estimated that more than 500,000 individuals in Europe were affected by rare neurological diseases according to the European Reference Network for Rare Neurological Diseases - ERN-RND. Parkinson's Disease is the most common disease in the large spectrum of neurodegenerative disorders characterized by movement disorder and this affected more than 1 million persons over 55 years old in the United States. In response to the COVID-19 pandemic, movement disorders followed up by all forms of telemedicine usage increased across almost all of the countries in the world. In most countries, the patient's first contact is the primary care physician and it is important to disseminate the knowledge of primary care among movement disorders. It is important to be aware of and be an expert in neurological symptoms for diagnosing rare movement disorders. Due to technological improvements, it is feasible to implement continuing medical education and on-the-job training programs among MDs to exchange information, training, and skill. © 2022 Nova Science Publishers, Inc.

Impact of the COVID-19 pandemic on patients with Parkinson's disease and other movement disorders

Introduction: The coronavirus disease-19 (COVID-19) pandemic is a global health crisis that has directly and indirectly impacted almost all populations globally. In this study, we aimed to study the impact of the COVID-19 pandemic on motor and nonmotor symptoms in patients with various movement disorders who visited our outpatient department. Materials and Methods: We conducted a prospective study using a structured questionnaire involving patients who visited our outpatient department during the COVID-19 pandemic from May 2020 to April 2021. The study was conducted at the Department of Neurology at the National Institute of Mental Health and Neuro Sciences, Bangalore. Results: A total of 208 patients with the following disorders were assessed: Parkinson's disease (n = 141), atypical parkinsonism (n = 31), dystonia (n = 15), Wilson's disease (n = 5), and other disorders (n = 16). Approximately, 3.5% of the patients had acquired the COVID-19 infection. Almost 80% of the patients had missed scheduled appointments with their physicians during this study period due to travel restrictions or the fear of traveling. Approximately, 50% of the patients experienced worsening of their motor and nonmotor symptoms. Approximately, 25% of patients availed teleconsultation facilities, and majority of them found it to be equivalent to or better than in-person consultation. Almost 80% of the patients were eager to receive the COVID-19 vaccination. Conclusion: The COVID-19 pandemic resulted in worsening of both motor and nonmotor symptoms in patients with movement disorders. Teleconsultation is a helpful option in managing the patients' symptoms during the pandemic. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

A CLASSIC CASE OF CREUTZFELDT-JAKOB DISEASE (CJD)

CASE: A 64-year-old woman was brought in by husband for inability to care for patient. Previously active, she developed gait instability, slurred speech, and memory lapse to the point of selective mutism and being bed-bound within three months. Her medical history was notable for hypertension and Covid four months prior. She had had mild upper respiratory symptoms and recovered in ten days. Examination revealed general encephalopathy, dysarthria, limited ability to follow commands. She had decreased strength but increased tone and rigidity in all extremities. She had rhythmic jaw movement and bradykinesia with scatter myoclonic movements. Cerebellar exam was notable for ataxia, but she had normal cranial nerve and sensory exams and normal reflexes. MRI of the brain revealed restricted diffusion and T2/Flair signal abnormality involving bilateral basal ganglia, ventral medial thalami, hippocampi, and cerebral cortices. Toxic metabolic workup was unrevealing. CSF was positive for 14-3-3 protein and elevated total tau protein, confirming Creutzfeldt-Jakob disease. IMPACT/DISCUSSION: Creutzfeldt-Jakob Disease (CJD) is a prion disease with one in a million prevalence. Patients present with rapidly progressing dementia, myoclonus, and signs of cerebellar, corticospinal and extrapyramidal involvement including nystagmus, ataxia, hyperreflexia, spasticity, hypokinesia, bradykinesia, dystonia, and rigidity. CJD is fatal within months to two years. Patients with end stage disease may have akinetic mutism. Magnetic resonance imaging (MRI), electroencephalogram (EEG), and cerebrospinal fluid (CSF) analysis are important for evaluation of CJD. Most sensitive in early stages, MRI Brain commonly shows hyperintense signal involving the cerebral cortex, corpus striatum, caudate, and putamen. EEG may capture pattern of periodic bi-or triphasic period sharp wave complexes. CSF might detect 14-3-3 protein with elevation of tau protein but real-time quaking-induced conversion (RT-QuIC) has the highest specificity for diagnosis for CJD. Though brain biopsy is the sole method of definitive diagnosis, results of MRI, EEG, and CSF analysis along with presenting signs and symptoms are sufficient for clinical diagnosis of CJD. Our patient's dementia, myoclonus, ataxia, hypokinesia, bradykinesia, dystonia, and rigidity all progressing to akinetic mutism within three months are classic presentation of CJD. EEG was normal, but MRI with hyperintensity of basal ganglia and cerebral cortices and CSF analysis with positive 14-3-3 and elevated tau proteins are all lead to diagnosis of CJD. CONCLUSION: This case illustrates a classic case of a Creutzfeldt-Jakob Disease, a rare prion disease marked by rapidly progressive dementia with neuropsychiatric features.

RESTING TREMOR AFTER COVID-19 INFECTION

CASE: The patient is a 66 year-old woman with history of hypertension and recovered COVID-19 presenting to the outpatient clinic for eight months of persistent resting tremor of her left arm. The tremor started shortly after she developed headache, fatigue, and epistaxis found to have COVID-19. The tremor is mild, occurs multiple times throughout the day, and usually resolves spontaneously after several seconds. The patient denies any paresthesias, muscle weakness, motor slowing, or ataxia. She has no family history of Parkinson's disease or essential tremor. On physical exam, vital signs are normal. Motor strength is 5/5 and sensation is intact throughout. Brachioradialis deep tendon reflex is 1/4 bilaterally though slightly increased on the right side. Cranial nerves II through XII are intact. Gait is normal with no evidence of shuffling. No pronator drift is evident. No cogwheel rigidity is noted. Finger-to-nose motion is normal. Throughout the appointment, the patient is noted to have an intermittent mild resting tremor in her left arm that lasts several seconds and resolves spontaneously. Laboratory results including a basic metabolic panel and thyroid stimulating hormone level are normal. Incidentally, the patient underwent a recent brain MRI for chronic sensorineural hearing loss that showed normal appearance of the internal auditory canals/ middle ear structures and no evidence of intracranial pathology. The patient was subsequently started on daily propranolol. A subsequent telemedicine visit one month later revealed that her resting tremor had nearly resolved. IMPACT/DISCUSSION: The outpatient presentation of resting tremor warrants consideration of a broad differential that includes Parkinson's disease and other causes of parkinsonism, including neurodegenerative diseases and essential tremor, among others. Furthermore, previous studies have demonstrated new onset movement disorders associated with COVID-19 including myoclonus, ataxia, action/postural tremor, catatonia, dystonia, chorea, and functional movement disorders. The exact pathophysiology of COVID-19 related movement disorders is not well understood. Of note, these prior studies did not specifically address evaluation of COVID-19 related movement disorders in the outpatient setting. CONCLUSION: The patient described above likely developed new onset left arm tremor secondary to COVID-19. Her reassuring physical exam findings, laboratory results, and head MRI suggest against other etiologies. The patient was successfully treated with propranolol. This case demonstrates the importance of neurologic assessment in the outpatient setting, particular in patients with a history of COVID-19 diagnosis. Though limited data exists on outpatient evaluation and management of movement disorders secondary to COVID-19, it is important to recognize this phenomenon as a potential diagnosis.

The impact of the reclusion on patients with blepharospasm during the COVID19 pandemic.

BACKGROUND: Blepharospasm (BS) is a focal dystonia that can be treated successfully with Botulinum toxin (BoNT). During the reclusion due to the Covid 19 pandemic many patients missed the scheduled treatment. OBJECTIVES: Aim of the study is to evaluate Level of Disability (LoD) related to BS during the lockdown period. METHODS: LoD was assessed by an adapted version of Blepharospasm Disability Index (4iBSDI) during reclusion (T1), and three months after the first injection following the lock down phase (T2). 4iBSDI scores were compared between T1 and T2, a correlation between the change of LoD in the two periods (t-delta) and patients' clinical data was analyzed. RESULTS: LoD was not modified between the two periods in most of the patients and it was reduced at T1 in almost one third of the participants. No correlation between t-delta and clinical data was found. CONCLUSIONS: LoD did not increase during the lock down period in most of BS patients although BoNT treatment was suspended. Environmental and psychosocial factors may contribute to determine the LoD due to BS.

Pilot Feasibility Study of a Multi-View Vision Based Scoring Method for Cervical Dystonia.

Abnormal movement of the head and neck is a typical symptom of Cervical Dystonia (CD). Accurate scoring on the severity scale is of great significance for treatment planning. The traditional scoring method is to use a protractor or contact sensors to calculate the angle of the movement, but this method is time-consuming, and it will interfere with the movement of the patient. In the recent outbreak of the coronavirus disease, the need for remote diagnosis and treatment of CD has become extremely urgent for clinical practice. To solve these problems, we propose a multi-view vision based CD severity scale scoring method, which detects the keypoint positions of the patient from the frontal and lateral images, and finally scores the severity scale by calculating head and neck motion angles. We compared the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) subscale scores calculated by our vision based method with the scores calculated by a neurologist trained in dyskinesia. An analysis of the correlation coefficient was then conducted. Intra-class correlation (ICC)(3,1) was used to measure absolute accuracy. Our multi-view vision based CD severity scale scoring method demonstrated sufficient validity and reliability. This low-cost and contactless method provides a new potential tool for remote diagnosis and treatment of CD.