Neurology Minute

In part one of this series, Dr. Andy Southerland and Dr. Dan Ackerman discuss what stands out in the latest thrombolysis guidelines, how these decisions are applied in stroke center practice, and how to educate residents and fellows on incorporating new evidence into treatment choices. Show transcript: Dr. Andy Southerland: Hi. This is Andy Southerland from the University of Virginia, and for today's Neurology Minute, I'm speaking with my friend and colleague, Dan Ackerman, Chief of Neurology and Director of Stroke at St. Luke's University Health System. I've been speaking with Dan on the main neurology podcast regarding updates to acute stroke treatment related to the 2026 American Heart Association guidelines that came out in late January of this year on the early management of patients with acute ischemic stroke. For our episode today, we might focus our discussion around thrombolytic therapy thrombolysis, which is at the core of what we do as acute stroke neurologists when it comes to treatment decision-making. So maybe as a first prompt, Dan, when you look at these guidelines, what stands out to you as you're thinking about how you practice, how you all are practicing at your stroke center, and then specifically how we educate our residents, our fellows on what they need to know, particularly the newness of it when it comes to making thrombolysis treatment decisions? Dr. Dan Ackerman: With all the discussions we've had in the past, there have been a lot of specifics about certain studies and how they might affect practice, but this guideline really opened up a lot and gave us an opportunity to do things in a way that makes really good clinical sense and really brings a lot of practices that have now become common at some centers into the fore so that we can get that information out to everyone and make sure everyone has that same really high level of stroke care everywhere they go. I think the first thing that stands out to me is what did not change. And want to reinforce that, particularly for people who are just getting into this, stroke alert is a screening tool, not a severity score. It's not like an MI alert where you do an EKG and you see the tombstone wave and you say, "Oh, there's an MI and we're taking them to treatment." This is a screening tool, so it is meant to be highly sensitive at the cost of being specific. At our shop for a long time now, we have initiated stroke alert for anyone who presents either within 24 hours of acute onset of neurologic symptoms or has an unknown onset of acute neurologic symptoms and they are still symptomatic to some degree at the time of their presentation, and that's it. We don't make any other statements about how severe something is or what kinds of symptoms someone necessarily has to have. We purposely keep it as broad as possible, again, because we're trying to screen. And the other thing that has not changed, time is still bra

In the third episode of this series, Dr. Stacey Clardy discusses treatment options and ongoing management. Show transcript:  Dr. Stacey Clardy: This is The Neurology Minute. I'm Stacey Clardy from the Salt Lake City VA at the University of Utah. This is the third episode today in our four-part series on Rett syndrome, and we're going to talk about treatment options and ongoing management. There is still no curative therapy for Rett syndrome and management remains largely supportive and multidisciplinary. But there is now an FDA-approved treatment, trofinetide, for adults and children two years of age and older with Rett syndrome. Trofinetide is a synthetic analog of glypromate. It's thought to modulate neuroinflammation and synaptic function, right? Because Rett syndrome involves difficulty with synaptic function. Clinical trials demonstrated improvements in some of the core Rett symptoms, but of course, as always, treatment decisions are going to require an individualized discussion, particularly given some common adverse effects such as diarrhea and vomiting. Beyond disease-specific therapy, management remains symptom driven. Given that epilepsy is common and may be refractory, careful EEG correlations are often necessary. Of course, the breathing abnormalities like hyperventilation and apnea are fairly characteristic and can fluctuate over time so need to be monitored, and gastrointestinal dysfunction, nutritional challenges, other sleep disturbances, and scoliosis require ongoing monitoring and intervention when relevant. Rehabilitation therapies, physical, occupational, and speech, are foundational throughout life. A key principle here is anticipatory management, right? Many of the complications, like cardiac conduction abnormalities and bone health issues, can be identified early and addressed early with better outcomes when Rett syndrome patients have coordinated care. That's it for today. Be sure to listen to the other Neurology Minute episodes in this series on Rett syndrome, and check back for our next and final episode, where we will cover care team essentials and multidisciplinary management. I'm Stacey Clardy for the minute.

Dr. Margarita Fedorova discusses the effectiveness of shunting for idiopathic normal pressure hydrocephalus. Show citation: Luciano MG, Williams MA, Hamilton MG, et al. A Randomized Trial of Shunting for Idiopathic Normal-Pressure Hydrocephalus. N Engl J Med. 2025;393(22):2198-2209. doi:10.1056/NEJMoa2503109 Show transcript: Dr. Margarita Fedorova: Welcome to Neurology Minute. My name is Margarita Fedorova and I'm a neurology resident at the Cleveland Clinic. Today we're reviewing a randomized trial that provides high quality evidence for treatment we've been using for decades, shunting for idiopathic normal pressure hydrocephalus. The PENS trial, a placebo controlled effectiveness and iNPH shunting trial was published in the New England Journal of Medicine in December 2025 by Luciano and colleagues. This international multicenter study enrolled 99 patients across the United States candidate in Sweden. While idiopathic normal pressure hydrocephalus or iNPH is characterized by triad of gait impairment, cognitive decline in urinary continence, these findings can be non-specific and we mass factor in radiological findings too. Furthermore, while CSF shunting has long been the standard treatment, its effectiveness has never been rigorously confirmed in a large well-powered randomized trial. In this trial, patients with a clinical improvement in gait velocity after temporary CSF drainage were deemed eligible for shunting and randomizing the trial. What makes this trial particularly elegant is its blending strategy. All 99 participants underwent the same surgical procedure with the same commercially available programmable shunt valve. After surgery, the valve was set either to an open functioning position or to a high resistance placebo setting. Neither patients nor assessors knew who had a working shunt. This is about as close to a true double-blind design as neurosurgery can get. The primary outcome was changing gait velocity at three months. The open shunt group improved by 0.23 meters per second on average, while the placebo group showed essentially no change in 0.03 meters per second. That's a treatment difference of 0.21 meters per second, both statistically significant and clinically meaningful. To put that in perspective, a change of 0.10 meters per second is considered the threshold for substantial meaningful change in the elderly. 80% of the open shunt group exceeded that threshold compared to only 24% of the placebo group. The Tenet scale, which measures gait imbalance, also showed significant improvement in the open shunt group. However, screening measures for good condition using the MoCA scale and bladder symptoms did not reach significance at three months, though tertiary outcomes for cognitive testing, quality of life and functional independence tended in favor of shunting. I

Dr. Casandra MacLeod discusses central retinal artery occlusions, recent trials, and those anticipated in the future. Show citation: Préterre C, Gaultier A, Obadia M, et al. Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA): a multicentre, double-dummy, patient-blinded and assessor-blinded, randomised, controlled, phase 3 trial. Lancet Neurol. 2025;24(11):909-919. doi:10.1016/S1474-4422(25)00308-4 Poli S, Grohmann C, Wenzel DA, et al. Early REperfusion therapy with intravenous alteplase for recovery of VISION in acute central retinal artery occlusion (REVISION): Study protocol of a phase III trial. Int J Stroke. 2024;19(7):823-829. doi:10.1177/17474930241248516 Ryan SJ, Jørstad ØK, Skjelland M, et al. A Randomized Trial of Tenecteplase in Acute Central Retinal Artery Occlusion. N Engl J Med. 2026;394(5):442-450. doi:10.1056/NEJMoa2508515 Show transcript: Dr. Casandra MacLeod Hello, this is Casandra MacLeod, a neurology resident at Cleveland Clinic with today's Neurology Minute. Today we will be discussing central retinal artery occlusions, or CRAOs, and the recent trials that have come out and even those further on the horizon. The 2026 American Heart Association and American Stroke Association guidelines for the early management of patients with acute ischemic stroke were recently published and in them highlight the uncertainty around the treatment of acute CRAOs with intravenous thrombolysis, even when the patient presents within four and a half hours and is otherwise eligible. These guidelines come after two recent trials, which we will further discuss. The thrombolysis in patients with acute central retinal artery occlusion, or the THEIA trial, was published in the November issue of Lancet Neurology. This multicenter trial out of France randomized 70 patients with acute CRAOs presented within four and a half hours of time from last known well to either receive IV alteplase and oral placebo or IV placebo and oral aspirin. While safety measures showed no symptomatic hemorrhage event, although they did have one asymptomatic intracerebral hemorrhage occur, the primary outcomes, which included visual acuity improvement at one month, showed some evidence for a trend of improved acuity in the IV thrombolytic group at 66% compared to 48 in the aspirin group, it did not reach significant. And now more recently, the Tenecteplase in central retinal artery occlusion study, or TenCRAOs, was published in the January 2026 issue of The New England Journal of Medicine. TenCRAOs was a six European country multicent

Dr. Gregg Day and Drs. Sonia Vallabh and Eric Minikel discuss scientific insights and the future of prion disease treatment, highlighting the importance of early diagnosis, personalized medicine, and hope for affected families.  Learn about the clinical trial.   Learn more about the Prion Alliance.  Show transcript:  Dr. Gregg Day: This is Gregg Day with Neurology Minute. I've just been speaking with Eric Minikel and Sonia Vallabh, a husband and wife team at the heart of the PRiSM trial, a first-in-human study of a prion protein-lowering, divalent, small-interfering RNA for patients with symptomatic prion disease. Eric and Sonia, could you provide us with a brief overview of the PRiSM trial and what this first-in-human study seeks to accomplish? Dr. Eric Minikel: The PRiSM trial is testing a short interfering RNA designed to bind the RNA that encodes the prion protein. That is the protein that causes Prion disease. We are at the heart of what causes this disease. Through doing this, we hope to make prion disease a treatable and preventable condition. We both want to stabilize symptomatic patients and prevent the disease in people who are at genetic risk. This is a personal mission for us. Sonia is a carrier of a prion disease mutation that she inherited from her mother who died of prion disease, and we, along the way, aspire to be a different kind of sponsor. We want to create our own clinical data that are shareable learnings for the entire field. Dr. Gregg Day: This is Gregg Day with Neurology Minute. Thanks for listening.

In the second episode of this series, Dr. Tesha Monteith and Dr. Peter Goadsby discuss the prediction of treatment responses for personalized medicine. Show transcript: Dr. Tesha Monteith:  Hi, this is Tesha Monteith with The Neurology Minute. Today I'm speaking with Peter Goadsby from the Division of Biomedical Sciences at King Abdullah University of Science and Technology about key trends in headache medicine and some of the most impactful research presented at the AAN annual meeting. Can you talk a little bit about prediction of treatment response for personalized medicine? Dr. Peter Goadsby I hope that AI gives us some direction. I haven't seen anything yet, but I don't think we've done enough with it to make it stunning yet. I think that the AI systems ... I'd love to know, for example ... I've been using triptans for 30 years and apart from using sumatriptan first when [inaudible 00:00:51] had a triptan simply because it's the commonest triptan, which is generally what I do, that's a pretty naff rule when you think about it. I'd like to think that AI systems could work out where we should be going in terms of acute therapy, preventive therapy, whether there are particular red flags or amber flags you might say in a person's broad history. I don't think we've got there yet, but I actually think we will get there. I think we'll be surprised and we'll learn things about the biology of the disorder and about the pharmacology of these medicines, which must have subtle differences because we all see people who respond to one and don't respond to another, and you sort of scratch your head, but you're happy that it happens. Dr. Tesha Monteith:  I agree with you, and I think the future is really bright for headache medicine and the potential of AI to move the needle. Peter, thank you again for joining us and sharing your insights. I really appreciate you being on. This is Tesha Monteith. Thank you for listening to The Neurology Minute.

In the second episode of a four-part series on Rett syndrome, Dr. Stacey Clardy discusses the importance of early referrals, particularly during the regression phase.  Show transcript:  Dr. Stacey Clardy:  This is the Neurology Minute. I'm Stacey Clardy from the Salt Lake City VA and the University of Utah. This is the second episode in a four-part series on Rett syndrome. Today, let's discuss when to refer and specifically early referral is absolutely critical in Rett syndrome, particularly during the regression phase. Any child, most often a girl with previously acquired developmental milestones who begins to lose language or lose purposeful hand use or develops stereotyped hand movements should prompt urgent neurologic evaluation. This would be referral to pediatric neurology, of course, and this should not wait for genetic confirmation. Early involvement of pediatric neurology allows for diagnostic clarification, anticipatory guidance, and coordination of care across systems. The genetic testing, typically with MECP2 sequencing and deletion or duplication analysis, this should be pursued early and if initial testing is negative but suspicion remains high, expanding that genetic evaluation is warranted. And beyond neurology, early engagement with developmental services, speech, occupational, and physical therapy should start before even a definitive diagnosis is necessarily established. Rett syndrome is a multi-system disorder. So a care team is going to monitor for common comorbidities. This is not just epilepsy, but also gastrointestinal dysfunction, breathing abnormalities, and orthopedic complications. When delayed referrals occur, it's often due to attribution of regression to more common developmental conditions. Be sure to listen to the other Neurology Minute episodes in this series. We'll be back next time for our third episode, and we'll cover treatment options and ongoing management.

Dr. Margarita Fedorova discusses whether a vaccine ingredient is quietly protecting the brain. Show citation: Taquet M, Todd JA, Harrison PJ. Lower risk of dementia with AS01-adjuvanted vaccination against shingles and respiratory syncytial virus infections. NPJ Vaccines. 2025;10(1):130. Published 2025 Jun 25. doi:10.1038/s41541-025-01172-3 Show transcript: Dr. Margarita Fedorova: Welcome to Neurology Minute. My name is Margarita Fedorova, and I'm a neurology resident at the Cleveland Clinic. Today we're exploring a study that raises a compelling question. Could a vaccine ingredient be quietly protecting the brain? A recent study by Taquet et al., published in npj Vaccines in 2025, investigated whether vaccination with an AS01-adjuvanted vaccine is associated with a lower risk of dementia. You might know it as the immune-boosting ingredient in Shingrix, the shingles vaccine, and Arexvy, the new RSV vaccine. We already know from prior work that the Shingrix vaccine was associated with a reduced risk of dementia, but the question this paper asks is why. Is it because preventing shingles itself protects the brain, or is there something specific about the adjuvant that's doing the work? To answer this, the researchers used a large US electronic health record database comparing over 35,000 people who received the AS01-adjuvanted RSV vaccine, over 100,000 who received the AS01-adjuvanted shingles vaccine and over 78,000 who received both. Each matched against individuals who got the seasonal flu vaccine instead. The findings were interesting. People who received the RSV vaccine had a 29% lower risk of new dementia diagnosis over the following 18 months. Those who received the shingles vaccine had an 18% increase in time without dementia, and those who received both had a 37% increase in dementia-free time. Here's a key insight. Both vaccines target completely different viruses, but both contain the same adjuvant. The fact that a similar protective signal was seen with both suggests the benefit may not be about which virus is prevented, and it may be about the AS01 itself. Why might an adjuvant protect the brain? AS01 contains two active components, monophosphoryl lipid A, known as MPL, and QS21. Together they activate macrophages and dendritic cells, triggering cascade that includes a production of interferon gamma. In animal models, stimulation of a receptor called toll-like receptor 4, which MPL activates, has been shown to reduce Alzheimer's-like pathology. The authors also point out that the protective effect appears within just a few months of vaccination, which is hard to explain purely by prevented infections and may point instead to a direct immunological mechanism. Very important caveat. This is an observational study, not a randomized

In the final episode of this series, Dr. Justin Abbatemarco and Dr. Ruth Dobson discuss navigating conversations with women and their families about potential ocrelizumab exposure during pregnancy and breastfeeding.  Read more about this abstract on the AAN website.

In the first part of this series, Dr. Tesha Monteith and Dr. Peter Goadsby discuss some major themes that emerged from the AAN Annual Meeting regarding headache medicine.

Dr. Alex Menze and Dr. Breton Asken discuss the long-term impacts of repetitive head impacts in football players, focusing on inflammation, brain microstructure, and cognitive decline. Show citation:  Emanuel OM, Miner AE, Lee SY, et al. Inflammation, Limbic White Matter Microstructure, and Clinical Symptoms in Retired American Football Players With Repetitive Head Impacts. Neurology. 2026;106(6):e214646. doi:10.1212/WNL.0000000000214646

In the first episode of a four-part series, Dr. Stacey Clardy discusses the diagnosis and clinical presentation of Rett syndrome.

In part two of this series, Dr. Justin Abbatemarco and Dr. Ruth Dobson discuss the main findings of this study.   Read more about this abstract on the AAN website.

In part one of this series, Dr. Justin Abbatemarco and Dr. Ruth Dobson discuss current evidence on monoclonal antibodies in pregnancy and breastfeeding and prior understanding of CD20 therapies.  Read more about this abstract on the AAN website.

Dr. Justin Abbatemarco and Dr. Kait Nevel discuss tips and tricks for managing radiation necrosis in hospitals and outpatient settings.  Show transcript:  Dr. Justin Abbatemarco: Hello, and welcome. This is Justin Abbatemarco, and I just finished interviewing Kate Neville about radiation necrosis following radiosurgery. Kait is a neuro-oncologist at Indiana University. Kait, maybe we could just start with what this entity looks like and some tips and tricks on how we can manage in that hospital or in the outpatient setting when we were picking this up. Dr. Kait Nevel:  Yeah. Radiation necrosis can present in a variety of ways. People with radiation necrosis can be completely asymptomatic. In fact, most patients with radiation necrosis are asymptomatic. But symptoms can include things like headaches, seizures, and then focal neurologic deficits related to where the radiation necrosis is located. Imaging-wise, radiation necrosis typically looks like necrotic enhancing lesion as the name implies. Typically, we look at certain anatomical characteristics on standard MRI like vague enhancement along the edges, et cetera, but perfusion can be very helpful including cerebral blood volume, which is typically low in cases of radiation necrosis and high in cases of tumor progression. But this is a really big challenge in neuro-oncology, and differentiating radiographically between tumor and radiation injury. Dr. Justin Abbatemarco: I would encourage people to listen to podcast. We talked a little bit about medications, how to dose dexamethasone and others, and how we think through that. So please jump on and take a listen, and then join us back for the next Neurology Minute. We're going to talk about some evidence for supplement use in this disease. So Kait, thank you.  Dr. Kait Nevel: Great. Thank you.

Dr. Alex Menze and Dr. Kathryn C. Fitzgerald discuss using accelerometry to detect subtle, longitudinal changes in disability in people with multiple sclerosis and how these changes relate to brain atrophy and disability progression.  Show citation:  Fitzgerald KC, Sanjayan M, Dewey BE, et al. Association of Changes in Activity Patterns With Brain Atrophy and Disability Progression in People With Multiple Sclerosis. Neurology. 2026;106(7):e214678. doi:10.1212/WNL.0000000000214678  Show transcript:  Dr. Alexander Menze: Hi, this is Alexander Menze. I just finished interviewing Kate Fitzgerald for the Neurology Podcast. For today's Neurology Minute, Kate, I'm hoping you can tell us the main points of your paper. Dr. Kathryn C. Fitzgerald:  So we followed 238 people with MS who are 40 or older for over three years and they wore risk-worn accelerometers roughly every three months and had regular clinical assessments and brain MRI. And what we found was that changes in activity patterns over time at the individual level were associated with subsequent changes in disability worsening and brain volume loss, particularly in the deep gray matter and thalamus. Dr. Alexander Menze: Thank you very much. Be sure to download this week's podcast to hear our full interview.

In the second part of this series, Dr. Katie Krulisky and Dr. Cristina Domínguez-González explore the most effective approach to evaluating suspected mitochondrial disease. Show citation: Bermejo-Guerrero L, Restrepo-Vera JL, Martin-Jimenez P, et al. Clinical Heterogeneity and Candidate Biomarkers in POLG-Related Mitochondrial Disease. Neurol Genet. 2026;12(2):e200365. Published 2026 Mar 10. doi:10.1212/NXG.0000000000200365  Show transcript:  Dr. Katie Krulisky: This is The Neurology Minute. This is the second part of our series. I'm Katie Krulisky from the University of Utah and I'm here with Cristina Domínguez-González from the 12th of October University Hospital and its affiliated health research institute in Madrid, Spain. We've just recorded a full podcast on our paper, Clinical Heterogeneity and Candidate Biomarkers in POLG-related Mitochondrial Disease, which has been published in Neurology Genetics. Cristina, for The Minute, what's the most practical way to work up suspected mitochondrial disease today? Dr. Cristina Domínguez-González:  In practice, everything starts with the clinical picture. Recognizing the pattern, whether it's a combination of features or a more subtle isolated presentation, is what should first raise suspicion. From there, you decide the next step. Targeted genetic testing if the phenotype is well-defined, grow their sequencing if it is less clear or more complex. Biomarkers can also be very helpful. GDF15, Growth Differentiation Factor 15, is markedly elevated in many mitochondrial diseases and can support the suspicion. In myopathies in particular, it is especially useful because of its high negative predictive value helping to rule out a mitochondrial cause when levels are not elevated. And finally, muscle biopsy still has a role. It can provide important information in selected cases, particularly in adults or when genetic results are inconclusive, both for diagnosis and also to guide further studies. Dr. Katie Krulisky: Thank you. That's super helpful. And for more on mitochondrial diseases and POLG-related disorders, have a listen to the full neurology podcast. Again, I'm Katie Krulisky from the University of Utah with Cristina Domínguez-González  from the 12th of October University Hospital and its affiliated health research institute in Madrid, Spain.

In the last episode of the series, Dr. Stacey Clardy and Drs. Deborah Hall and Deborah Setter discuss some practical changes that can immediately improve lactation support in neurology workplaces.  Show transcript: Dr. Stacey Clardy: This is the Neurology Minute. I'm Stacey Clardy from the Salt Lake City VA and the University of Utah. I've just had a fantastic in depth podcast discussion with Deborah Hall from Rush University and Deborah Setter from Olmsted Medical Center on their paper titled Workplace Lactation in Neurology: Barriers and Opportunities. You can find that in Neurology Clinical Practice. Deborah Hall, what are some practical changes that can immediately improve lactation support in neurology workplaces? Dr. Deborah Hall: One practical change that could be considered is to plan immediately when you know a provider will be going out on maternity leave. Prior to departure, you can plan what that schedule's going to look like when that provider returns. Ensure that they have those 30 minute breaks every two to three hours in their inpatient or outpatient schedule. Make sure that there's a space for them and have them go look at it that would be appropriate for their lactation breaks. You want to make sure they have that dedicated refrigerator for breast milk storage. And finally, make a plan for compensation. It's really important that they understand how their productivity targets and how compensation will be affected by the breaks that they will be taking. Dr. Stacey Clardy: Easy to make changes, right? And as we discuss in the full-length podcast, please everyone take a listen to this. This is something we can all improve on to support all of our colleagues in neurology. Please have a listen to the full-length podcast. We give you everything that you need to know to be a better support to your colleagues. Thanks so much, Deborah.

In the May episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost provide a leadership perspective on the 2026 Annual Meeting. Stay informed by watching the President's Spotlight video. Show transcript: Dr. Jason Crowell: Hey, this is Jason Crowell with today's Neurology Minute. Once again, we have Natalia Rost joining us for our monthly check-in. Of course, Natalia is the president of the AAN. Natalia, thanks for joining us again this month. Dr. Natalia Rost: Hi, Jason. Dr. Jason Crowell: So what have you been up to since we last spoke a month ago? Dr. Natalia Rost: Well, as you know, we just came back from Chicago, where our 2026 AAN annual meeting took place, and of course, it's the largest gathering of neurologists and neuroscience professionals worldwide, so not a small feat. We welcome this time a record-breaking 16,000 plus participants in person in Chicago and online, representing 110 countries and all 50 states, what I call a microcosm of the global neurology community. It was amazing, and an opportunity to step back, reflect, and be reminded that progress in neurology happens not in isolation, but through our shared purpose and collaboration, and the energy and optimism coming out of this meeting is something I'm so proud of. Dr. Jason Crowell: I can only imagine what a whirlwind week that is for you. So now that it's past us and you reflect back, what stands out to you from the week? Dr. Natalia Rost: Well, it was clear during that meeting that we're advancing what comes next and that's why science and research was at the heart of the week and why sustained investment in discovery matters. I had the privilege of seeing colleagues modeling leadership in neurology, both on stage and behind the scenes and attendees engaged with cutting-edge science, shared insights across disciplines, and bringing those new insights and techniques home to their practices, institutions, and communities. Dr. Jason Crowell: Now, your presidential plenary at the meeting was about neuroscience at the crossroads. What would you say is the most urgent challenge facing our neurology community right now? Dr. Natalia Rost: You know, as a physician scientist myself, I'm focused on how to sustain progress at this moment of rapid scientific advancement. Our neurology community is gathering extraordinary volume of knowledge, but translating that momentum into durable impact requires continued commitment to research, workforce development and collaboration across disciplines are key topics. And I feel that this is a pivotal time for our field. Dr. Jason Crowell: And if I could ask you to just briefly take off your president hat for a moment, personally, what was your favorite thing about the week?

In part one of this series, Dr. Katie Krulisky and Dr. Cristina Domínguez-González discuss when a neurologist should start thinking about mitochondrial disease.  Show citation: Bermejo-Guerrero L, Restrepo-Vera JL, Martin-Jimenez P, et al. Clinical Heterogeneity and Candidate Biomarkers in POLG-Related Mitochondrial Disease. Neurol Genet. 2026;12(2):e200365. Published 2026 Mar 10. doi:10.1212/NXG.0000000000200365  Show transcript:  Dr. Katie Krulisky: This is The Neurology Minute, and this will be a two-part series. I've had the pleasure of speaking with Cristina Domínguez-González from the 12th of October University Hospital and its affiliated Health Research Institute in Madrid, Spain. I'm Katie Krulisky from the University of Utah. We've just recorded a full podcast on our paper, Clinical Heterogeneity and Candidate Biomarkers and POLG-related Mitochondrial Disease, which has been published in Neurology Genetics. So for our first minute, Cristina, when should a neurologist start thinking about mitochondrial disease? Dr. Cristina Domínguez-González: Mitochondrial diseases are among the most common inherited neurological disorders. Think of them whenever you see compatible features like ptosis ophthalmoplegia, polyneuropathy, ataxia or myopathy, especially when they occur in combination. But even when these features appear in isolation, mitochondrial disease should still be part of the differential. This is particularly important because many patients do not present with a full classical picture, especially in early the disease course. In practice, this means maintaining a low threshold to consider mitochondrial disease, even in a typical presentations. Dr. Katie Krulisky: Thank you so much. And for more information on mitochondrial disease and POLG-related disorders, do listen to the full neurology podcast. Again, I'm Katie Krulisky from the University of Utah with Cristina Domínguez-González from the 12th of October University Hospital and its affiliated Health Research Institute in Madrid, Spain.

In the first episode of this series, Dr. Stacey Clardy, along with Drs. Deborah Hall and Deborah Setter, discusses the most overlooked barrier to effective lactation support in neurology today.  Show citation:  Hall D, Setter D, Ullrich N, et al. Clinical Workplace Lactation in Neurology: Barriers and Opportunities. Neurol Clin Pract. 2026;16 (3) e200611. Published 2026 Apr 17. doi:10.1212/CPJ.0000000000200611 Show transcript:  Dr. Stacey Clardy: This is the Neurology Minute. I'm Stacey Clardy from the Salt Lake City VA in the University of Utah. I've just had a great discussion with Deborah Hall and Deborah Setter about their paper, Workplace Lactation in Neurology: Barriers and Opportunities. Deborah Setter, my question for you for the minute is what is the most overlooked barrier or barriers to effective lactation support in neurology today? Dr. Deborah Setter: I think the biggest barrier is that lactation is a knowledge gap for neurologists. I was surprised to find out that a lactating person needs a 20 to 30-minute break every two to three hours to maintain their milk supply, prevent complications of insufficient milk expression, and to meet their personal lactation goals. Dr. Stacey Clardy: Awareness is key. I admit that I didn't even know the details surrounding the federal law in the United States regarding this as well. There is so much more in our full podcast discussion, so please take a listen. This is essential listening for all of us in neurology to help our field do better and to support our colleagues. Thanks so much, Deborah.

In the last episode of this series, Dr. Justin Abbatemarco and Dr. Benjamin P. Trewin discuss how to apply this data into clinical practice.   Read more about this abstract on the AAN website.   Show transcript:  Dr. Justin Abbatemarco: Hello, and welcome back. This is Justin Abbatemarco and I'm joined by Benjamin Trewin where we're reviewing top abstracts from the AAN annual meeting in Chicago. Today we're talking about his abstract maintenance immunotherapy and MOGAD, early steroid benefit, dose thresholds, and disability risk. Ben, we've done this really great job of dissecting the data, steroids, non-steroidal agents. How do you think about the treating MOGAD cases in clinic though? How do you try to put this data and the data we've talked about into clinical practice? Dr. Benjamin P. Trewin: It's obviously a very good and actionable question, and our research has always tried to focus on these dilemmas facing the clinician at the bedside. And so the way that we think about this is, of course, we try to come up with some rules or some guidelines to treat all patients, as that's the most effective way of giving the message, but we need to acknowledge there is variation within MOGAD patients. There are people with low relapsing propensity who will take a very long time to relapse. You'll need to follow them for a long time. And there are ones with high relapsing propensity. So some of our previous work, we actually reviewed thousands of MOGAD patients in the literature and found that if you follow them for more than five years, over 70% actually relapse. It's just a matter of following them. So acknowledging this variation in the patients is important, but at the same time, the guideline we would probably endorse based on our research is that all patients with MOGAD after a first attack should be treated with oral corticosteroid taper, including at least five months of 12.5 milligrams per day oral corticosteroids. Now, how does that work in practice? Well, you would probably start them, and I say probably here because we don't have the strength of evidence for the very start of the course and the very end. But what did we do? Well, we start them at about one milligram per kilogram. And over probably about two to three weeks, you can bring them down to about 12.5 milligrams per day, or in children, 0.16 milligram per kilogram per day. And then you'll do that four or five months. And then over two or three weeks after that, you would step them down. Of course, you want to be careful that you don't have any adrenal issues. You would want to go slow enough for that. But at the same time, you don't want to prolong the course too long and put yourself at risk of side effects. Dr. Justin Abbatemarco: I think that's really helpful and practical. And you don't need these huge doses, i

In the second episode of this series, Dr. Justin Abbatemarco and Dr. Benjamin P. Trewin discuss what was found in non-steroidal maintenance therapies. Read more about this abstract on the AAN website. Show transcript: Dr. Justin Abbatemarco: Hello and welcome back. This is Justin Abbatemarco from the Cleveland Clinic. And we're joined by Ben Trewin on his abstract maintenance immunotherapy and MOGAD, early steroid benefit, dose thresholds and disability risk. Ben, in our first episode we really talked about corticosteroids, but your paper and abstract looked at other therapies. What did you find in those non-steroidal maintenance therapies? Dr. Benjamin Trewin: In addition to looking at oral corticosteroid therapies, we also looked at B-cell depleting therapies, namely rituximab and ocrelizumab, and intravenous immunoglobulin and steroid-sparing therapies, namely azathioprine and mycophenolate predominantly, I suppose a couple on methotrexate. Now, what we found, it's important to note that we were able to tease apart the effects of all these drugs with our Cox proportional hazard model chops up, follow up into distinct intervals with different combinations and permutations of these medications and their different doses in a more granular way than is allowed by previous techniques like incident rate ratios when we compare pre and post annualized relapse rate, and we think this is a strength of the study. With this methodological strength, we were able to see that steroid-sparing therapies, despite 334 patient years of data, do not appear to have any independent benefit with respect to time to next relapse. The estimate of effect there was 1.06. And then for time to confirm sustained disability, there was also no confidence signal, the confidence interval being 0.15 to 1.4, that it actually prevented any disability despite a wealth of data, which I think is an important thing to note. And I think previous studies, particularly looking with incident rate ratios, have been a little more optimistic with that. And I think there might be misattributing some of the benefit of concomitant steroids to the steroid-sparers, but it's more complex than that, of course. And then with respect to B-cell depleting therapies, we did have 48 of 261 patients exposed, which is reasonable, but not quite enough to get the signal we're looking for. However, we found something quite interesting, because when we compared the Liverpool data to the Australasian data, the two big study groups involved, we saw that it wasn't quite as effective in Liverpool as it was in Australasia in this subgroup analysis. And so we dug a little deeper, as one should, and found that the dosing is actually different. And in Australasia, we have a tendency to just give two grams of rituximab up front, or 600 milligrams of ocreli

In the second part of this series, Dr. Justin Abbatemarco and Dr. Paulus Rommer discuss how to apply these study results into clinical practice.  Show citation:  Vietzen H, Kühner LM, Berger SM, et al. Epstein-Barr Virus Antibodies to Differentiate Multiple Sclerosis From Other Neuroinflammatory Diseases. JAMA Neurol. Published online March 9, 2026. doi:10.1001/jamaneurol.2026.0240  Show transcript: Dr. Justin Abbatemarco: Hello and welcome back. This is Justin Abbatemarco, and we're finishing up our interview with Paulus Rommer on his article on JAMA Neurology, Epstein-Barr Virus Antibodies that differentiate multiple sclerosis from other Neuroinflammatory Diseases. Paulus, can we talk about how we would apply your results into clinical practice right now? Dr. Paulus Rommer: The persistent high apnea antibody responses are a hallmark of multiple sclerosis. And in our micro center study, we found that the singular measurement is not sufficient to differentiate multiple sclerosis from other related disorders like MOGAD or NMOSD, but it's the repeated high levels over time. We see them in about 95% of our MS patients, but really rarely in MOGAD or NMOSD. So this persistent high levels is a good factor, with a high accuracy, to really diagnose multiple sclerosis and to differentiate them from MOGOD or NMOSD. Dr. Justin Abbatemarco: I think these are really helpful and I think a little more evolution in how we interpret these on individual patient level, like we talked about in the podcast, but more to come. Paulus, thank you again for all your work on this topic for coming on and we're excited to have you back in the future. Dr. Paulus Rommer: Thank you.

Dr. Zohaib Siddiqi and Dr. Laurence Poirier discuss a complex stroke case associated with systemic vasculitis, highlighting diagnostic challenges and management strategies, including the role of endovascular therapy.  Show citation:  Poirier L, Brissette V, Shamy MCF, Maxwell JP, Drake B, Fahed R. Clinical Reasoning: A 70-Year-Old Man With Systemic Illness Related Strokes Refractory to Medical Treatment Managed With Intracranial Stent. Neurology. 2025;104(1):e210068. doi:10.1212/WNL.0000000000210068

In part one of this series, Dr. Justin Abbatemarco and Dr. Paulus Rommer discuss the relationship between Epstein-Barr virus and multiple sclerosis, as well as the questions that still remain unanswered. Show citation: Vietzen H, Kühner LM, Berger SM, et al. Epstein-Barr Virus Antibodies to Differentiate Multiple Sclerosis From Other Neuroinflammatory Diseases. JAMA Neurol. Published online March 9, 2026. doi:10.1001/jamaneurol.2026.0240

In part one of this series, Dr. Justin Abbatemarco and Dr. Benjamin P. Trewin discuss the major findings from his work.  Read more about this abstract on the AAN website.

In this episode, Dr. Jason Crowell discusses the Capitol Hill Report from April 20th, which provides updates on federal funding for neuroscience research in fiscal year 2027 (FY2027).  Stay updated with what's happening on the hill by visiting aan.com/chr.  Learn how you can get involved with AAN advocacy.

Casey Kozak discusses the process of applying to neurology residency. This episode offers insights for applicants and for neurologists who guide and mentor the next generation of neurologists.

Dr. Andy Southerland and Dr. Layne Dylla discuss the trends in head CT use in US emergency departments from 2007 to 2022, highlighting disparities, regional variations, and the potential role of AI in optimizing imaging decisions.  Show citations:  Dylla L, Krothapalli N, Tu L, et al. Trends in Head CT Use in US Emergency Department Patients From 2007 to 2022: A Nationwide Analysis. Neurology. 2025;105(12):e214347. doi:10.1212/WNL.0000000000214347

Dr. Stacey Clardy talks with Dr. Alison Christy, the recipient of the 2026 Ted Burns Humanism in Neurology Award, about her inspiring career, innovative approaches to neurology education, and how she fosters compassion and creativity in medicine.

Dr. Tesha Monteith talks with Ayesha Sohail about her abstract titled "Global Burden of Headache Disorders in Older Adults (Aged ≥ 55 Years) from 1990-2021: An Analysis of Epidemiology, Trends, and Socioeconomic Disparities."  Read more about this abstract on the AAN website.

In the final episode of this series, Dr. Justin Abbatemarco and Dr. Shreya Louis discuss the study results and their implications for improving clinical practice.  Read more about this abstract on the AAN website.

In part two of this series, Dr. Justin Abbatemarco and Dr. Shreya Louis discuss how this technology was developed and how it has evolved.  Read more about this abstract on the AAN website.

Dr. Greg Cooper talks with Dr. Walter J. Koroshetz about his advice for early neurologists.  Read more about the 2026 AAN President's Award.

Dr. Greg Cooper and Dr. Eric Reiman discuss emerging antibody therapies for preclinical Alzheimer's disease and the clinical, regulatory, and equity considerations shaping prevention trials and future care. Show citation:  Reiman EM, Alexander RC, Langbaum JB, et al. A path to preventing cognitive impairment due to Alzheimer's disease: initiatives beginning in the USA. Lancet Neurol. 2026;25(3):268-278. doi:10.1016/S1474-4422(25)00483-1

In the first part of this series, Dr. Justin Abbatemarco and Dr. Shreya Louis discuss the background and evolving terminology around circulating tumor DNA, cell‑free DNA and CSF‑based testing in neurology.  Read more about this abstract on the AAN website.

In part two of this series, Dr. Tesha Monteith and Dr. Brett Lauring discuss the clinical trial design, including the objectives and methods. Read more about this abstract on the AAN website.

In this episode, Dr. Andy Southerland reviews the Capitol Hill Report from April 6th, focusing on news related to appropriations and several new bills. Stay updated with what's happening on the hill by visiting aan.com/chr.  Learn how you can get involved with AAN advocacy.

As we celebrate the 75th anniversary of Neurology®, Drs. Jeff Ratliff, Steven Galetta, and Robert Griggs discuss the history and evolution of the Letters to the Editor section. Join the conversation by visiting the Letters to the Editor section.

Dr. H.E. Hinson and Dr. Vijay Ramanan discuss the upcoming Clinical Trials Plenary Session at the AAN Annual Meeting and the landmark studies shaping neurological care. For more information about this event, visit the AAN website.

In part one of this series, Dr. Tesha Monteith and Dr. Brett Lauring discuss the potential role TRPM8 antagonist may play in the management of migraine.   Read more about this abstract on the AAN website.

In part two of this series, Dr. Justin Abbatemarco and Lizzy Lawrence discuss recent FDA guidance, focusing on broader agency changes and how this messaging differs from the FDA's traditional communication around regulatory decision-making. Show citation:  https://www.statnews.com/2025/12/04/fda-considers-single-clinical-trial-for-new-product-approvals/

In the March episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost discuss some of the most pressing challenges facing academic neurology while supporting neurologists in all practice settings.  Stay informed by watching the President's Spotlight video.

Dr. Derek Stitt and Dr. Page B. Pennell discuss antiseizure medication management during pregnancy and postpartum, based on the MONEAD study.  Show citation:  Pennell PB, Li D, Kerr WT, et al. Antiseizure Medication Dosing Strategy During Pregnancy and Early Postpartum in Women With Epilepsy in MONEAD. Neurology. 2026;106(2):e214483. doi:10.1212/WNL.0000000000214483

In part one of this series, Dr. Justin Abbatemarco and Lizzy Lawrence discuss the FDA's shift toward single-trial drug approvals.  Show citation:  https://www.statnews.com/2025/12/04/fda-considers-single-clinical-trial-for-new-product-approvals/

Dr. Halley Alexander and Dr. Mikael Guzman Karlsson discuss the development and evaluation of an AI-enabled clinical assistant designed to support time-sensitive decision-making in neurology. View the related abstract:  https://index.mirasmart.com/AAN2026/PDFfiles/AAN2026-003409.html

In part two of this series, Dr. Tesha Monteith and Dr. Nimish A. Mohile discuss the motivation behind the development of this roadmap to neurological health equity.  Show citation:  Patel PB, Hamilton RH, Budhu JA, et al. A Roadmap to Neurologic Health Equity: An AAN Position Statement. Neurology. 2026;106(5):e214687. doi:10.1212/WNL.0000000000214687

In the first part of this series, Dr. Tesha Monteith and Dr. Nimish A. Mohile discuss what the roadmap is and how it is intended to benefit practicing neurologists. Show citation:  Patel PB, Hamilton RH, Budhu JA, et al. A Roadmap to Neurologic Health Equity: An AAN Position Statement. Neurology. 2026;106(5):e214687. doi:10.1212/WNL.0000000000214687

Dr. Greg Cooper and Dr. Sara Hassani discuss periprocedural brain health and call on neurologists to engage in multidisciplinary efforts to improve periprocedural outcomes. Show citation: Hassani S, Gorelick PB. Periprocedural Brain Health: The Scope of the Problem and the Neurologist's Role. Neurology. 2025;105(12):e214427. doi:10.1212/WNL.0000000000214427   Show transcript: Dr. Greg Cooper: Hi, this is Greg Cooper. I just finished interviewing Sara Hassani for this week's Neurology Podcast. For today's Neurology minutes, Sara, I'm hoping you can tell us the main points of your paper. Dr. Sara Hassani:  I would say that the central message of this paper is that paraprocedural neurologic complications, they're very common, and they may actually be as high as the third leading cause of mortality, and yet very few healthcare providers realize this. And furthermore, few healthcare providers are adequately prepared to discuss the risks of the various procedures with patients and/or their family members. Dr. Greg Cooper: Thank you for that summary and all your work on this topic. Please check out this week's podcast to hear the full interview, and read the full article published in Neurology, Paraprocedural Brain Health. Thank you.