Reviews & Analysis

Neurofilaments have been validated as specific body fluid biomarkers of neuro-axonal injury. In this Review, Khalil and colleagues provide an update on the structure and function of neurofilaments, analytical approaches and challenges in different clinical contexts, and progress towards clinical application of neurofilaments as a biomarker in various neurological disorders.

A computational neuroimaging study has shed new light on the relationship between morphological changes in the brain in schizophrenia and the network architecture of the brain, providing evidence to support two network theories of the disorder.

Various neurostimulation techniques are being explored for the treatment of physical impairments in people with stroke. This Review summarizes our current knowledge of the techniques that are now in clinical use or have reached the stage of pivotal trials alongside emerging techniques and highlights the need for further studies.

Post-traumatic epilepsy is a major driver of disability associated with traumatic brain injury. This article reviews the epidemiology and clinical features of post-traumatic epilepsy and discusses how an understanding of the underlying epileptogenic mechanisms might inform the development of anti-epileptogenic medications.

In this Review, the authors discuss the unique neurological health disparities faced by sexual and gender minority (LGBT+) people. The Review presents clinical considerations alongside language and practice recommendations to promote inclusive care, and highlights the gaps in need of further research.

Since its instigation in cancer research in the 1930s, the disease-staging concept has become a crucial tool in clinical research and medical practice. Two new papers have proposed biological staging and classification systems based on α-synuclein pathology for Parkinson disease and related conditions.

Recent clinical trials have highlighted the need for Alzheimer disease (AD) staging rather than simply noting the presence or absence of AD pathology. This article reviews current biomarker-based AD staging systems and outlines hypothetical frameworks to stage AD severity using fluid biomarkers.

Alzheimer disease is a complex and multifactorial condition. The authors of this Perspective suggest that its lack of a singular common pathogenesis prevents it from being regarded as a straightforward ‘disease’ and that treatment will therefore require a multifaceted approach.

In this Review, Hamilton dissects the importance of racial and ethnic diversity among the neurology workforce for providing inclusive and equitable care to diverse populations. The Review summarizes current barriers to achieving diversity in the field and presents strategic approaches to overcoming these.

Success in a trial of low-intensity ultrasound combined with an amyloid-β antibody represents a major stride towards integrating pharmacological and nonpharmacological approaches to reduce the amyloid-β load in patients with mild Alzheimer disease. This trial also highlights the potential of therapeutic ultrasound modalities to combat neurodegenerative diseases.

Growing evidence suggests a bidirectional relationship between Alzheimer disease and epilepsy. This Review summarizes the epidemiological evidence and explores the potential mechanisms that underlie the effects of epileptiform activity on cognition in people with Alzheimer disease.

This Review reviews changes introduced into the US brain death/death by neurological criteria (BD/DNC) guidelines in 2023 and compares these guidelines with those formulated elsewhere in the world. The authors highlight controversies and legal challenges in BD/DNC determination and discuss future research priorities.

A study now reveals that CSF, but not imaging, biomarkers for Alzheimer disease show weaker correlation to cognitive measures in Black people than in White people. The findings offer insights into Alzheimer disease biomarker utility across racially diverse groups.

Though the burden of stroke has declined, it has grown rapidly in low-income and middle-income countries, and disparities still exist within high-income countries. In this Review, the authors highlight under-acknowledged disparities in the burden of stroke and review strategies for addressing key inequalities.

In this Perspective, the authors discuss the need for neurologists to assist in court cases involving criminal behaviour that was potentially influenced by a neurological disorder. The authors review evidence linking neurological disorders with criminal activity, and advocate for the development of forensic neurology as a subspecialty of the field.

Parkinson disease psychosis comprises a spectrum of illusions, hallucinations and delusions that emerge during the disease course. This Review considers clinical, neuroimaging and neurochemical evidence that might aid early identification of psychotic phenomena in people with Parkinson disease and inform new therapeutic strategies.

Autonomic nervous system dysregulation contributes to the chronic, debilitating disorders referred to as ‘long COVID’ or post-acute sequelae of SARS-CoV-2 infection (PASC). Here, Goldstein describes a multisystem, multidisciplinary approach to understanding PASC-induced alterations in feedback-regulated, plastic networks that determine homeostasis and allostasis.

Increasing evidence suggests that inflammasome activation contributes to disease progression in a wide variety of neurological conditions. In this Review, Ravichandran and Heneka discuss current understanding of inflammasome activation in neurological disorders and consider interventional strategies that target inflammasome activation.

This Review provides a comprehensive summary of the growing number of molecular therapies for the treatment of myasthenia gravis, including monoclonal antibodies, B cell-depleting agents and chimeric antigen receptor T cell-based therapies.

In this Perspective, Zech and Winkelmann outline multidimensional strategies for genetic diagnosis in patients with rare movement disorders and highlight community-driven data-sharing and case-matchmaking platforms designed to foster the discovery of new genotype–phenotype relationships.