August Miravalle, MD, FAAN
“DIAGNOSE AND LAMP” was a phrase used to describe the management of neurological conditions in the late 1990s. As an example, that misconception was recognized as one of the factors behind neurophobia among medical students.1 The Decade of the Brain was established in 1989 to raise awareness and stimulate support for the advancement of basic and clinical neuroscience research, and the past 3 decades have brought an expanding armamentarium of therapies for many neurological disorders.
Perhaps the most impressive example is the approval of more than 20 disease-modifying therapies for multiple sclerosis (MS). As a result of different options with different degrees of clinical efficacy, the traditional model of escalation therapies, in which less effective treatments were used early in the course of the disease, is being replaced by a highly effective early therapy approach. Anti-B cell therapies are becoming recognized as among the most effective strategies to treat acute inflammation in MS and, in a sense, are changing the treatment paradigm. Despite their high efficacy in preventing relapses and focal inflammation in the central nervous system, these therapies have limited impact in addressing progression independent of relapse activity. In this issue of NeurologyLive®, Tyler Kaplan, MD, and I provide an overview of an exciting group of therapies—Bruton tyrosine kinase inhibitors—that have the potential to address this unmet need in MS. Similarly, Vincent Tran and Sarah Yang, MD, provide an expert review of recent advances in the amyotrophic lateral sclerosis treatment armamentarium.
Overcoming an early reputation as a cognitive specialty with limited treatments for our patients, neurology has evolved significantly in the past 20 years with advances in neuroimaging, therapeutics, biomarkers, and genomics. Additionally, the field of neurology is moving beyond treating neurological disorders alone and is beginning to understand how to prevent the development of neurodegeneration and use non-pharmacological approaches to maximize brain health. In reflection of this, the inaugural American Academy of Neurology (AAN) Brain Health Summit was held on September 15, 2022, in Washington, DC. As a result of that initiative, the AAN developed a strategic plan that outlines goals and tactics for incorporating brain health into neurology practice. In this issue of NeurologyLive®Jordan Acosta, MS, and Brett Fling, PhD, MS, elegantly outline recent advances in our understanding of how exercise affects overall brain health and influences disease progression in MS.
One in 6 individuals in the United States is affected by brain diseases, including stroke, Alzheimer’s disease, MS, migraines, and Parkinson’s disease. The quest to achieve ideal brain health in our communities is far from realized; however, an exciting change in our approach to managing neurological conditions resulting in a newly evolved field of brain health.
