News & Comment

Artificial intelligence and neurotechnology promise to transform neurological care, but their acceptance will depend on public trust. Such trust must be earned and maintained through responsible development, transparent reporting, public engagement and ethical oversight. Without these foundations, even highly beneficial technologies may fail to gain legitimacy or uptake.

Aspects of modern society, such as artificial lighting and rigid schedules, create ‘social jetlag’ — a mismatch between biological chronotypes and societal demands. This circadian misalignment particularly affects evening chronotypes, leading to sleep deprivation, mental health issues and physical disorders. Flexible schedules and environmental modifications could restore natural sleep patterns and improve well-being.

Implementation of patient and public involvement and engagement (PPIE) to enable patients and carers to feel included and equal to healthcare professionals is challenging to do well. Here, leaders of a PPIE group share their lived experience and highlight the importance of addressing the needs of all participants to enable true partnership.

Patient and public involvement and engagement is increasingly mandated in funding applications, yet often remain tokenistic and transitory. Working with patient and public contributors requires investment, thought, care and time. We discuss approaches that aim to increase agency for coresearchers, with the goal of strengthening public confidence and trust in research.

Dementia is largely excluded from discussion of noncommunicable diseases, which limits its inclusion in health policies and allocation of resources — yet it is already a leading cause of mortality and its effects are set to increase. Alzheimer’s Disease International calls for changes in policies to address the effects of dementia now and in the future.

The FDA recently approved efgartigimod for the treatment of chronic inflammatory demyelinating polyradiculopathy, providing an alternative to the immunoglobulin therapy that has been the standard treatment for years. The approval has the potential to improve access to treatment and outcomes, but many challenges remain in implementing trial findings into clinical practice.

Although lecanemab has been licensed for use in the UK, the systems to deliver this or similar disease-modifying therapies do not exist. These systems need to be developed urgently, but not at the expense of post-diagnostic care.

The importance of diet for brain health is increasingly recognized by neurologists, but many neurological disorders impair the ability of individuals to eat healthily. A new initiative known as ‘Food Is Medicine’ has the potential to facilitate healthier eating among people with neurological disorders to improve and maintain brain health.

Spinal cord stimulation is seen as a last-resort therapy for the treatment of chronic pain. Controversies surrounding the treatment might be addressed through collaborative efforts to conduct innovative clinical trials and reach consensus on treatment guidelines.

Similar to any innovation that disrupts the status quo, the advent of magnetic resonance-guided focused ultrasound in neurology was accompanied by controversy and debate. However, evidence suggests that this therapeutic tool, which is already widely used to treat tremor and Parkinson disease, is gaining acceptance and will become a viable therapeutic option for various other neurological conditions in the near future.

Advanced sensory feedback from upper limb prostheses would provide multiple benefits to people with upper limb amputations, but achieving functional and natural-feeling sensation is technologically challenging. Advances are being made with invasive and non-invasive stimulation approaches, but considerable challenges need to be addressed with technological innovation.

Neuromodulation represents a promising approach for promoting neural plasticity following a brain injury, especially for non-communicative patients with prolonged disorders of consciousness. However, so far, the outcomes have been limited and inconsistent, driving researchers to explore alternative strategies to improve the efficacy of brain stimulation techniques.

A non-invasive technique using transcranial electrical stimulation offers an improvement in focality over other non-invasive techniques, presenting an opportunity to target deep brain structures for the treatment of neurological disorders.

The use of non-invasive brain stimulation techniques to treat mild cognitive impairment and dementia in Alzheimer disease is expanding. Trials have produced varying results depending on the differing stimulation techniques, targeted brain regions and degrees of cognitive impairment among the treated cohorts.

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.