Perspectives

Here, the authors summarize the evidence concerning the neurological health of individuals affected by the 11 September 2001 terrorist attacks and present the outcome of a meeting convened by the US National Institute for Occupational Safety and Health that aimed to generate recommendations for future research in this population.

To date, all phase III trials of β-site amyloid precursor protein (APP)-cleaving enzyme (BACE) inhibitors for Alzheimer disease were either discontinued or produced negative results. Here the authors present their opinion that BACE inhibitors still hold promise as a preventative therapy for Alzheimer disease and outline a series of experiments to inform future trials.

The FDA recently granted accelerated approval to aducanumab for the treatment of Alzheimer disease. Here, the authors reflect on the events that led to this controversial approval and consider whether any lessons can be learned for the field.

The AT(N) system is a classification scheme based on biomarkers that reflect the core pathophysiological features of Alzheimer disease. This Perspective outlines the conceptual framework and clinical importance of the AT(N) system and considers its potential expansion to incorporate biomarkers for additional pathophysiological mechanisms.

In this Perspective, Makhani and Tremlett provide an overview of the evidence for a prodromal phase in multiple sclerosis, discuss possible characteristics and markers of this prodrome, and consider its profound clinical and research implications.

Several childhood disorders, including infantile colic and cyclical vomiting syndrome, are thought to be related to migraine. In this Perspective, Gelfand and Abu-Arafeh present evidence for each of these disorders to be considered as part of a ‘childhood migraine syndrome’.

In this Perspective, the authors discuss the steps necessary to achieve predictive modelling of neurological diseases with human induced pluripotent stem cells, including applications to diagnosis and prognosis in the context of a precision medicine paradigm.

In this article, members of the International Progressive MS Alliance discuss why experimental medicine trials are important for the development of treatments for progressive multiple sclerosis and set out their funding programme for such trials.

New tools are being developed for the standardization and digitization of clinical data from patients with multiple sclerosis. In this Perspective, D’Souza and colleagues address the multifaceted impact of these tools on patient care and highlight the challenges and opportunities they create.

In this Perspective, the authors discuss the mechanisms underlying the complex relationship between lesion size and functional recovery after spinal cord injury, highlighting various complications that can limit the accuracy of outcome prediction in patients and in animal models.

Acute respiratory distress syndrome is a common occurrence in COVID-19, an infectious disease caused by the coronavirus SARS-CoV-2. In this article, the authors consider how lung innervation might crosstalk with the immune system to modulate lung function and influence outcomes in COVID-19.

In this Perspective, Pezzini and Padovani critique the evidence for neurological manifestations of COVID-19, including epidemiological, neuropathological and neuroimaging data, and highlight the need for further work to establish whether SARS-CoV-2 is responsible for these symptoms.

In this Perspectives article, Jan Lünemann and colleagues discuss the potential of immune reconstitution therapies to induce remission in individuals with multiple sclerosis. They highlight our limited understanding of the mechanisms underlying this remission and suggest future areas of research.

Migraine is one of the world’s most prevalent diseases, and approximately 2% of the general population experiences chronic migraine. Edvinsson and colleagues argue that inflammation could have an important role in migraine chronification, through a mechanism termed neurogenic neuroinflammation.

Paterson and colleagues describe how stable isotope labelling kinetics (SILK) can be used to determine protein production and clearance rates. They highlight the promise of SILK studies for elucidating the role of pathogenic proteins in neurodegenerative diseases, including Alzheimer disease.

In the future, robotic devices that augment human care provision could transform dementia services and support. In this Perspectives article, Moyle discusses upcoming challenges in dementia care and suggests guidelines for the development and integration of smart assistive technologies.

Here, Bouthour et al. argue that the success of closed-loop deep brain stimulation based on electrophysiological biomarkers in patients with Parkinson disease could inspire novel treatments for other neuropsychiatric disorders in which symptoms are driven by pathological activity in motor, cognitive and limbic brain networks.

The opioid crisis constitutes a public health challenge at the intersection of two interrelated medical problems — opioid addiction and chronic pain. In this Perspectives article, Volkow and Koroschetz discuss how neurologists are uniquely positioned to help address the opioid crisis.

In this Perspectives article, Smith et al. address the misconceptions about the clinical and pathological features of chronic traumatic encephalopathy that cause confusion and controversy not only in the public but also among health-care professionals.

The development of treatment for multiple sclerosis over the past 25 years is a success of translational medicine. In this Timeline article, Tintore et al. chart major developments and discuss the implications for current and future patient management.