Neurology has been transformed over the past decade. Stroke treatment windows have expanded. Multiple sclerosis therapy has moved from modest immunomodulation to high-efficacy B-cell depletion. Alzheimer's disease has its first disease-modifying therapies. Epilepsy has new mechanisms of action entering clinical practice. This guide covers how neurologists can efficiently track evidence across these rapidly moving subspecialty domains.
Acute ischemic stroke care has changed more in the past decade than in the preceding half-century. Time windows for IV thrombolysis have expanded. Mechanical thrombectomy has been established as standard of care through a series of landmark trials (MR CLEAN, ESCAPE, DAWN, DEFUSE-3). Secondary prevention has been refined through POINT, CHANCE, and THALES. A neurologist practicing 2016 stroke protocols in 2026 is practicing on substantially outdated evidence.
Key journal for stroke: Stroke (AHA), JAMA Neurology, NEJM for landmark trials, and The Lancet Neurology.
MS therapeutics have fundamentally changed with the emergence of high-efficacy therapies — anti-CD20 agents (ocrelizumab, ofatumumab, ublituximab), natalizumab, and cladribine. The debate between escalation vs. early high-efficacy therapy has major implications for how neurologists counsel newly diagnosed patients. Key journals: Multiple Sclerosis Journal, JAMA Neurology, Neurology, NEJM for major trials.
The ECTRIMS-EAN guidelines and AAN quality measures for MS management are updated periodically and provide the most practical framework for clinical decision-making.
MS surveillance note: The pipeline for progressive MS therapies — phenylbutyrate, ibudilast, simvastatin — is evolving rapidly. Neurologists managing progressive MS patients should monitor trial results specifically in PPMS and SPMS, where treatment options remain most limited.
The FDA approvals of lecanemab (Leqembi, 2023) and donanemab (Kisunla, 2024) represent the first disease-modifying therapies for early Alzheimer's disease with traditional FDA approval. This creates entirely new clinical decisions for neurologists:
The Alzheimer's Association and CTAD (Clinical Trials on Alzheimer's Disease) conference are the primary venues for emerging data in this space.
Epilepsy pharmacotherapy has expanded with new-generation agents targeting multiple mechanisms (cenobamate, fenfluramine for Dravet syndrome, cannabidiol for specific epilepsy syndromes). Genetic epilepsy diagnosis — SCN1A, KCNQ2, CDKL5 — is now clinically relevant with precision medicine implications for specific antiseizure medication choices. Key journal: Epilepsia, JAMA Neurology.
The American Academy of Neurology publishes clinical practice guidelines across all major neurological conditions. Guidelines are rated by evidence quality and incorporate systematic literature reviews. Key recently updated or actively updated AAN guidelines include:
CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) and gepants (ubrogepant, rimegepant, atogepant) have transformed migraine prophylaxis and acute treatment since 2018. Real-world evidence and comparative effectiveness data continue to accumulate. The American Headache Society position statements provide the most up-to-date clinical guidance between major guideline updates.
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