Comment

The recent approval of omaveloxolone for the treatment of Friedreich ataxia in the USA and Europe represents an important milestone in the field of rare neurological diseases. However, many challenges lie ahead, including the translation of trial results into clinical practice, and the management of patients’ expectations.

Glyphosate, a controversial herbicide, has been approved for use in the European Union for another 10 years despite uncertainty over whether it increases the risk of neurodegenerative disorders such as Parkinson disease. We call for new approaches to assessing the neurotoxicity of glyphosate and other pesticides and improving their regulation.

Artificial intelligence-based tools have the potential to transform health care, enabling faster and more accurate diagnosis, personalized treatment plans, new therapeutic approaches and effective disease monitoring. Artificial intelligence shows particular promise for the management of rare neurological disorders by augmenting knowledge and facilitating the sharing of expertise among physicians.

Data-driven approaches hold considerable promise for medical breakthroughs in the precision and cost-effectiveness of the prevention, diagnosis and treatment of neurodegenerative diseases. The scientists and health care professionals who will be responsible for providing the evidence to support these approaches must also consider the ethical challenges involved in the care of people with intellectual impairments.

Artificial intelligence has emerged as a powerful tool for predicting protein structure. This technology is now being applied to improve our understanding of protein aggregation in neurodegenerative and other neurological disorders, and could potentially improve disease management by enabling precision medicine.

Deep brain stimulation (DBS) is a well-established approach for treating movement disorders such as Parkinson disease, dystonia and essential tremor. However, the outcomes are variable, and researchers are now exploring artificial intelligence-based strategies to help improve DBS procedures.

The overarching theme of the ninth Congress of the European Academy of Neurology (1–4 July 2023) is ‘neurology beyond big data’. The Congress provides an opportunity for neurologists, neuroscientists and other experts to discuss how the power of neurological data might be harnessed to advance discovery and improve patient outcomes and brain health.

Digital technologies for data collection and remote monitoring can offer several indubitable advantages in neurological disorders. However, an equitable future for the use of digital technology in neurology will be possible only with global, collaborative and multidisciplinary planning that should be promptly prepared and implemented.

A growing understanding of the neurobiology of psychosis offers hope for an improvement in the standard of care; this includes the development of individualized, precision therapeutics. However, the path to precision psychiatry is long, and progress would be accelerated by greater collaboration with the fields of neurology and neuroscience.

Prediction tools offer great promise for clinicians in the prevention and treatment of psychosis, but none has been routinely implemented. Greater methodological rigour in the development and evaluation of these tools, along with consideration of a range of performance criteria, is necessary to maximize their potential for improving clinical decision making.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.