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  • Responding to increasing concerns around adverse brain health outcomes among former football (soccer) players, the Football Association of England recently announced a trial ban on heading in matches for players aged under 12 years. This is a step in the right direction, but wider interventions to preserve brain health should not be forgotten.

    • William Stewart
    • Alan Carson
    Comment
  • 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
  • Neurological diseases cause a massive burden, which will increase as populations age. Rapid advances in our understanding of disease mechanisms must be translated into human benefits. We cannot stop once technologies have been developed, but must ensure that evidence and pipelines are in place for their implementation to reduce burden and inequalities.

    • Anthony G. Marson
    Comment
  • On the basis of a coverage decision for anti-amyloid monoclonal antibodies recently issued by the US Centers for Medicare and Medicaid Services, Medicare will offer ‘coverage with evidence development’ to allow more information on the clinical benefits of these antibodies to be gathered. Here, we discuss the implications of this decision for future clinical trials and Alzheimer disease care.

    • David Knopman
    • Mary Sano
    • Howard H. Feldman
    Comment
  • Demographically adjusted norms that include sociocultural factors such as race can provide an evidence-based approach for addressing the chronic systemic and diagnostic inequities in the interpretation of neuropsychological tests. However, these norms have important limitations, and more work is needed to improve the diagnostic validity of neuropsychological assessments in diverse populations.

    • Desiree A. Byrd
    • Monica G. Rivera-Mindt
    Comment
  • Several studies indicate that, in individuals infected with herpes simplex virus and/or varicella zoster virus, antiviral therapy reduces the subsequent risk of Alzheimer disease and other types of dementia. As highlighted in this article, the preventative potential of antiviral therapy would probably be maximized by treating asymptomatic as well as symptomatic infected individuals.

    • Ruth F. Itzhaki
    Comment
  • In India, the peak of SARS-CoV-2 infections in May 2021 was paralleled by an outbreak of rhino-oculo-cerebral mucormycosis (ROCM) — a fungal infection affecting the nose, eyes and brain. This outbreak provided a unique opportunity to study the neurological manifestations of ROCM and to investigate new treatments for the condition.

    • Gagandeep Singh
    • Venugopalan Y. Vishnu
    Comment
  • The burden of epilepsy among forcibly displaced persons is thought to be high, and access to treatment is limited. In June 2021, the WHO Secretariat published a draft intersectoral action plan aimed at redressing the global epilepsy treatment gap, providing a valuable opportunity to improve epilepsy treatment for forcibly displaced persons.

    • Farrah J. Mateen
    Comment
  • The African Stroke Organization has been inaugurated as a pan-African coalition of stroke researchers, clinicians, allied health-care professionals, national and regional stroke societies and stroke support organizations in response to the escalating burden of stroke in the continent.

    • Rufus O. Akinyemi
    • Michael Brainin
    Comment
  • The amyloid antibody aducanumab is currently undergoing review by the FDA. The treatment would be the first disease-modifying drug to be approved for Alzheimer disease; however, a medical advisory committee recently convened by the FDA did not recommend approval, raising questions about whether the existing evidence of efficacy is sufficient.

    • Howard Fillit
    • Allan Green
    Comment
  • Despite the development of many new anti-seizure drugs over the past two decades, around one-third of individuals with epilepsy are without effective treatment. This pharmacoresistance is poorly understood, but new treatments targeting epileptogenesis instead of seizures have shown potential in animal models and are now being translated into the clinic.

    • Holger Lerche
    Comment
  • Following extensive progress in the treatment of relapsing multiple sclerosis, the major challenge in the field is now to develop effective therapies for progressive forms of multiple sclerosis. As the first signs of success emerge, now is the time to consider the research needed to move the field forward.

    • Alan Thompson
    • Olga Ciccarelli
    Comment
  • The introduction of therapies for spinal muscular atrophy (SMA) has rapidly changed the clinical landscape, transforming SMA from a lethal to a treatable disease. This transformation has driven further advances, from population screening imperatives to novel treatment delivery approaches, while uncovering health disparities and fuelling debate regarding drug pricing.

    • Michelle A. Farrar
    • Matthew C. Kiernan
    Comment
  • Despite the strong treatment effects of mechanical thrombectomy in acute ischaemic stroke, penumbral tissue loss before recanalization and ischaemia–reperfusion injury after diminish functional outcomes and call for adjunct treatments. Classical neuroprotection strategies could consequently be revived, but novel treatment targets are also emerging through mechanistic research.

    • Guido Stoll
    • Mirko Pham
    Comment
  • Despite negative findings from numerous clinical trials of potential disease-modifying therapies for Alzheimer disease, amyloid remains the most compelling therapeutic target. Advances in biomarker methods now enable accurate monitoring of Alzheimer disease progression from the earliest stages of the disease. We must therefore redouble efforts to find an effective treatment.

    • Michael S. Rafii
    • Paul S. Aisen
    Comment
  • In current usage, ‘concussion’ describes a clinical presentation, but does not identify the underlying pathological process and therefore cannot be considered a true diagnosis. However, mounting evidence indicates diffuse axonal injury as a likely pathological substrate for concussion, thereby providing a framework to develop true diagnostic criteria.

    • Douglas H. Smith
    • William Stewart
    Comment