Neurological conditions and COVID-19

Neurological conditions and COVID-19

Last updated 30 March 2020

Authors: Dr Pam Collins, Consultant Occupational Physician, Healthwork Ltd
Dr Kerry McNeil, Consultant Occupational Physician


Neurological condition








Alzheimer’s Disease Likely low in working population

No increased risk, provided the breathing and swallowing muscles are functioning well. Increases to very high with reduced mobility and frailty.

Ataxia and spino-cerebellar hereditary/degenerative disorders Very high or high

not at increased risk of acquiring infection but at increased risk of severe symptoms.  Very high risk if swallowing difficulties , taking immuno-suppressants, reduced mobility, other co-morbidity

Bulbar palsy Very high
BMI >40 elevate to next risk level
Cavernoma Increased or low

Not at increased risk of infection.  Only at increased risk of complications if neurological impairment

Cerebral Palsy Likely to be low in working population
Charcot Marie-Tooth very high down to low depending on extent of disease

likely to be low in working population

same risk as the general public‘ unless requiring CPAP or NIV or suffering vocal paralysis

No risk to uncomplicated Charcot-Marie-Tooth

Comorbidity Elevate risk appropriately, particularly for conditions of lungs, heart and kidney
Down’s syndrome very high to low depending on co-morbidity

no evidence of particular risk, but Down’s syndrome may be more at risk from infections generally and respiratory infections in particular. Consider co-morbidity;- respiratory conditions, heart disease, diabetes, and immunodeficiency. A number of those with Down’s syndrome will fall within these higher risk groups.

Epilepsy Low

Employees with mild to moderate epilepsy, with no breathing or swallowing difficulties, are unlikely to be at increased risk from COVID-19

Glycogen storage disease High to low

depends on co-morbidity and impairment

Headache/Migraine Low

Lack of evidence available. Immunosuppression not usually a feature, but there may be co-morbidities increasing risk.

Hydrocephalus Very high to low

in general not at increased risk other unless other co-morbid conditions

Idiopathic Intra-cranial Hypertension Low

but increased if BMI >40, common in this group

Immunosuppressive medication



Mycophenolate mofetil

Combined with oral prednisolone ≥ 20mg daily

Very high

Immunosuppressive medication




Very high or high
Inflammatory disorders




Very high or high

Risk conferred by immunosuppression and also by any co-morbidities [e.g. renal or lung disease] Some patients may have bulbar or respiratory weakness that confers additional risk

Inflammatory disorders

Chronic inflammatory demyelinating poly neuropathy and amyloid / paraprotein neuropathies

Very high to low

Immunoglobulin does not increase the risk of infection.  Risk conferred by immunosuppression.  High risk if cardiac involvement in amyloid disease

Mitochondrial disease Very high or high

risk of decompensation or cardiomyopathy

Motor Neurone Disease or Spinal Muscular Atrophy Very high

particularly patients with bulbar or respiratory muscle weakness

Multiple Sclerosis

Immunosuppression combined with oral prednisolone ≥ 20mg daily


No medication


Very high




MS patients are not significantly at risk from COVID-19, unless they have advanced disability with swallowing or breathing difficulties, or they are receiving selected immunotherapies.

includes specific MS drug guidance

Muscular dystrophies or diseases



Very high or high if active disease

Increased risk due to respiratory muscle weakness + co-existing interstitial lung disease which is common in these patients and other overlap connective tissue disorders. May be on steroids or other immunosuppression.

Muscular dystrophies



Limb girdle dystrophies

X-linked etc.


Very high or high

Increased risk due to respiratory muscle weakness + co-existing interstitial lung disease which is common in these patients and other overlap connective tissue disorders. May have weak cough or cardiomyopathy.

Very high if FVC<60%.

Myasthenia Gravis

Congenital myasthenia with previous respiratory involvement or needing nocturnal ventilation

Lambert Eaton myasthenic syndrome with substantial respiratory involvement

Immunosuppression plus Prednisolone ≥ 20mg daily

Very high
Myasthenia Gravis

Lambert Eaton myasthenic syndrome without substantial respiratory involvement

On immunosuppression

Myasthenia Gravis

Ocular myasthenia

Well controlled adult congenital myasthenia without respiratory involvment in the last 10 years and normal sleep studies

Narcolepsy/Cataplexy Low
Parkinson’s Disease Increased or low in working population

Parkinson’s itself does not put you in the extremely vulnerable group but there is an increased risk of complications. Likely to be very high if significant disability / advanced disease / in care

Peripheral neuropathy Low

No evidence of increased risk unless immunosuppressed, respiratory or swallowing issues or other co-morbidities

Spina Bifida Very high to low

in general not at increased risk other unless other co-morbid conditions


Vulnerability levels

Very high (Red)

Risk of severe illness or death if contracts COVID-19. Read more

High (Orange)

Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more

Increased/Moderate (Yellow)

Increased risk compared with healthy individual but should recover.

Low/Standard (Green)

No greater risk than healthy individual.