Background: There is concern amongst the MS community regarding increased risk of COVID-19 infection in patients on Disease Modifying Therapies (DMTs) Guidance from the Association of British Neurologists (ABN) recommends to continue most oral DMTs during the pandemic Objectives: To identify number of patients on oral DMTs in a single centre who reported COVID-19 symptoms To identify how this compares to national infection rate, whether there was a link to lymphocyte counts prior to infection and how many patients stopped or interrupted treatment Methods: Patients on oral DMTs (dimethyl fumarate (DMF), teriflunomide (TF) & fingolimod (FING)) were identified through a local database The pharmacy team called these patients to advise on DMT monitoringduring the pandemic Patients were also asked if they had experienced any symptoms of COVID-19 infection, had been tested, or had stopped treatment Recent lymphocyte counts were obtained Results: 501 patients on oral DMTs were identified (14 on TF, 169 on FING, 318 on DMF) 50% of these were contacted (DMF=174, FING=71, TF=10) The average age of those on treatment was 45, average EDSS 2 2, and average time on DMT 3 7 years Of those asked 90% (229) reported that they had not exprienced COVID-19 symptoms 10% (26) reported that they had experienced COVID- 19 symptoms (3 on TF, 8 on FING, 15 on DMF) According to a recent study by the UK Office of National statistics, of those individuals providing blood samples in the UK, 7% tested positive for antibodies to COVID-19 Of those who reported symptoms the last recorded lymphocyte counts were all within accepted ranges, with a mean of 1 2 (TF 2 0, DMF 1 5, FING 0 4) One patient taking DMF died due to COVID-19 Further data will be presented on the average lymphocyte counts in those who did not report symptoms, number of patients who went on to be tested for COVID-19 and the number who stopped or interrupted treatment Conclusions: Results present real world data on COVID-19 infection in patients on oral DMTs for MS and how these relate to lymphocyte count and infections rates in general population

Rituximab has potential indications in neurology not as yet studied in RCTs making access difficult but also means that there is no coherent process to ensure useful outcome data is acquired. In addition alternatives such as immunoglobulins now have limited availability. We set up a multidisciplinary team (MDT) to establish appropriate indication for rituximab, and ensure consistency of administration and outcome data collection.Data from neurosciences in Imperial Healthcare NHS Trust was audited (6/2010–4/2018). After completing a systematic review a MDT was initiated with peripheral nerve, epilepsy, and neuroinflammatory experts. The MDT was then audited (4/2018–1/2019).79 subjects were assessed: mean age 49.7±15.4 years (range 19–80yrs). 42 (5.4 per year) were treated since 2010 and 29 since the MDT began (34.8 per year). The commonest diagnoses were limbic encephalitis (17) and vasculitis (12). Subjects had on average 2.8 immune therapies prior to treatment. 21/71 had PLEX and 23/71 had immunoglobulins. Prior to the MDT inception 65% of subject reported positive outcomes. After the MDT 8 (19%) were rejected and there was minimal use in those without a clear diagnosis.Subjects who receive rituximab often have a series of in-hospital complex expensive therapies prior to treatment. A rituximab MDT increases its use in appropriate groups.

Why do some patients with Parkinson9s disease develop risk-taking behaviour? We assessed responses to novelty and willingness to take risks in 29 patients with idiopathic Parkinson9s disease (PD), compared to elderly controls and 14 PD patients with impulse control disorders (ICD). Participants were assessed on tasks designed to probe novelty processing and risk-taking behaviour. Akinetic-rigid PD patients, as well as those with ICD, were significantly quicker to respond to novel compared to nonnovel perceptually salient stimuli. By contrast tremor dominant PD patients and controls responded equally quickly to both types of stimuli. Faster reaction times to novel stimuli correlated with greater risk-taking on the Iowa Gambling Task for akinetic–rigid PD patients only. Importantly, there was no association between these measures and l-dopa equivalent dose. Instead, preserved structural integrity of mesolimbic regions (assessed with magnetisation transfer imaging) correlated with novelty-seeking in PD patients without ICD and increased risk-taking in the ICD patients. Akinetic-rigid patients tended to have higher levels of structural integrity here than tremor dominant patients. These results suggest that preservation of the mesolimbic dopaminergic system may play an important role in the development of ICD. Furthermore, our findings suggest akinetic–rigid patients may be more susceptible to developing these problems.

Section One: A. Original research papers in peer-review journals (215) B. Review articles in peer-review journals (31) Section Two: C. Book chapters in edited volumes (34) D.in press). Integration of goal-and stimulus-related visual signals revealed by damage to human parietal cortex. Journal of Neuroscience.in press). A role for the striatum in regret-related choice repetition. Journal of Cognitive Neuroscience. (in press). Retinal versus physical stimulus size as determinants of visual perception in simultanagnosia. Neuropsychologia. (in press). Studying the role of human parietal cortex in visuospatial attention with concurrent TMS-fMRI. Cerebral Cortex.in press). Biased figure-ground assignment affects conscious object recognition in spatial neglect. Cognitive Neuroscience.in press). Neural correlates of visual extinction or awareness in a series of patients with right temporo-parietal damage. Cognitive Neuroscience.