Simplified silhouettes of brains with different types of injury.

Neuroprognostication

A conceptual framework

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  • Low-resource settings lag behind the rest of the world in achieving good health, in part owing to poor translation of clinical evidence into practice. Focusing on neurological disorders — in particular, stroke — this Comment identifies barriers to translation at the individual, provider and health systems levels and proposes theory-driven mitigating solutions.

    • Mayowa O. Owolabi
    • Nijasri C. Suwanwela
    • Joseph Yaria
    Comment
  • Effective translation of evidence from clinical trials into clinical practice requires the enrolment of diverse, representative trial populations. However, this diversity is still often lacking, with negative clinical implications for under-served groups. Changes are needed to research practices and the broader research landscape to correct this problem.

    • Lynn Rochester
    • Camille Carroll
    Comment
  • The past 5–10 years have seen rapid advances in digital sensors and imaging-based technologies for the diagnosis of neurological conditions. However, the majority of these technologies are in the early stages of development — now is the time to consider how we validate these tools and safely integrate them into clinical practice.

    • Cristina Granziera
    • Tim Woelfle
    • Ludwig Kappos
    Comment
  • A growing number of clinical practice guidelines are being developed for neurological diseases, and they have the potential to benefit patients, clinicians, policymakers and payers. However, the effectiveness of these guidelines has not been evaluated, so we do not yet know whether they improve patient outcomes in a real-world setting.

    • Maurizio A. Leone
    • Joao Costa
    Comment

Treatment of multiple sclerosis

The first disease-modifying therapy for relapsing–remitting multiple sclerosis — interferon‑β 1b — was approved by the FDA in 1993. The following 25 years have seen rapid expansion of the therapeutic options as an evolving understanding of the disease has enabled development of therapies with different modes of action.
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