This 2025 literature review synthesizes significant advancements in treating and monitoring multiple sclerosis and related autoimmune central nervous system disorders. The text highlights breakthrough clinical trials for Bruton’s tyrosine kinase inhibitors, such as tolebrutinib and fenebrutinib, which offer new hope for slowing disability in progressive disease phenotypes. Beyond pharmaceuticals, the source examines the long-term success of stem cell transplants and the clinical utility of multi-protein serum tests for tracking neuroinflammation. It further explores specialized research into MOGAD and cognitive fatigue, advocating for more precise diagnostic frameworks and individualized patient care. Collectively, these documents illustrate a major shift toward precision medicine through the integration of novel biomarkers and real-world evidence.

This episode provides a comprehensive analysis of epilepsy research published throughout 2025, detailing major shifts in clinical diagnostics and treatment. It highlights a significant update by the International League Against Epilepsy, which simplified seizure classifications to improve global medical communication. The text evaluates the long-term success of modern medications like fenfluramine and cenobamate, while exploring the growth of precision medicine and minimally invasive surgeries such as laser therapy. Furthermore, the report examines how artificial intelligence and wearable technology are being utilized to predict seizures in real time. Finally, the source addresses global health inequalities, advocating for better access to genetic testing and specialized care in resource-limited regions.

This episodes summarizes the most significant research developments in stroke and neurovascular medicine throughout the year 2025. It details a shift in acute care where tenecteplase has emerged as the favored drug for bridging therapy before clot removal. Conversely, the text highlights that mechanical intervention for smaller or distant vessel blockages may not offer benefits over standard medical care. Advances in rehabilitation emphasize the effectiveness of high-intensity physical training, while new studies explore pharmaceutical options for stabilizing brain aneurysms and utilizing inflammatory biomarkers for risk assessment. Collectively, these sources provide a comprehensive update on clinical trials, technological innovations, and evolving guidelines aimed at improving patient recovery and prevention.

This comprehensive review synthesizes high-impact research from 2025 regarding movement disorders, specifically focusing on Parkinson’s disease and hereditary ataxias. The literature highlights critical clinical trial results, such as the failure of exenatide as a disease-modifying therapy and the burgeoning potential of stem cell regenerative medicine. It also identifies significant environmental risk factors, including a strong correlation between pesticide exposure near golf courses and increased disease prevalence. Furthermore, the sources examine the role of neuroinflammation as a predictor of dementia and the importance of sleep quality and cardiovascular exercise in patient management. Finally, the collection addresses diagnostic advancements in genetics and neuroimaging, offering a roadmap for more precise biomarker discovery and personalized treatment strategies.

This comprehensive review synthesizes high-impact research and clinical developments within the field of neuromuscular disorders throughout 2025. The paper details significant breakthroughs in therapeutic interventions, including novel gene therapies, complement inhibitors, and immune-modulating agents for conditions such as ALS and Myasthenia Gravis. It highlights updated clinical guidelines and the increasing utility of biomarkers to improve diagnostic accuracy and patient monitoring. Furthermore, the sources examine the role of global registries and the necessity of addressing demographic disparities to ensure equitable access to emerging treatments. Ultimately, the collection illustrates a shift toward precision medicine and individualized care for patients facing complex neurological challenges.

These papers provide a comprehensive overview of GLP-1 and dual GLP-1/GIP receptor agonists, highlighting their transformative role in treating type 2 diabetes and obesity. The texts detail the pharmacology and dosing of specific agents like semaglutide and tirzepatide, comparing their effectiveness in glycemic control and weight loss. Beyond metabolic health, the research explores emerging neurological benefits, investigating how these drugs might protect against stroke, Alzheimer’s, and Parkinson’s disease. While emphasizing clinical advantages such as cardiovascular and renal protection, the authors also address adverse effects like gastrointestinal distress and rare safety risks. Overall, the documents synthesize evidence from clinical trials to illustrate the expanding therapeutic landscape of incretin mimetics.

Patients diagnosed with epilepsy frequently encounter psychiatric and behavioral comorbidities, such as anxiety, depression, and ADHD, at rates significantly higher than the general population. This text outlines the pharmacological management of these conditions, emphasizing that effective seizure control often depends on addressing a patient's overall mental health and quality of life. Selective Serotonin Reuptake Inhibitors (SSRIs) are identified as the primary treatment for mood disorders, while atypical antipsychotics like aripiprazole and risperidone are recommended for managing aggression and emotional dysregulation. Additionally, the source evaluates the safety and efficacy of stimulants and nonstimulants for ADHD, noting that medications like methylphenidate are generally well-tolerated. Finally, the author suggests that selecting specific antiseizure medications, such as lamotrigine or valproate, can provide dual benefits by simultaneously stabilizing both seizures and behavioral symptoms.

This review explores the prognosis and treatment outcomes for individuals with focal epilepsy, a common neurological condition where seizures originate in specific brain regions. While roughly two-thirds of patients achieve seizure freedom using anti-seizure medications (ASMs), approximately one-third develop drug-resistant epilepsy (DRE). The authors highlight that despite the availability of over 30 different ASMs, overall success rates have not significantly improved in recent decades. The text emphasizes the importance of using standardized definitions from the International League Against Epilepsy (ILAE) to better identify treatment-resistant phenotypes and improve clinical research. Factors such as early age of onset, neurological deficits, and high pretreatment seizure frequency are identified as key risks for poor medical response. Ultimately, the review advocates for tailored treatment strategies and timely surgical referrals to mitigate the significant mortality and morbidity associated with uncontrolled seizures.

This research analyzes the global surge of early-onset Parkinson’s disease (EOPD) between 1990 and 2021, revealing that incidence and prevalence rates have nearly tripled worldwide. The study highlights a disproportionately high burden in Latin American countries, likely driven by specific genetic mutations and environmental factors such as arsenic contamination. While the disease is becoming more common globally, men and high-middle Socio-Demographic Index nations show the most significant increases in cases. The authors also explore the inverse relationship between smoking and EOPD, noting that while tobacco appears to have a protective effect, this influence has diminished over the last three decades. Ultimately, the report calls for targeted public health interventions to address the unique economic and social challenges faced by younger patients.

New-onset refractory status epilepticus (NORSE) and its subcategory, febrile infection-related epilepsy syndrome (FIRES), are rare clinical presentations characterized by the sudden onset of drug-resistant seizures in individuals without prior epilepsy. These conditions typically follow a biphasic course, beginning with a catastrophic acute phase of status epilepticus followed by a chronic phase of refractory epilepsy and significant cognitive impairment, and are increasingly viewed as immune-inflammatory-mediated encephalopathies involving innate immunity dysfunction. While acute management initially follows traditional protocols for refractory status epilepticus, expert consensus recommends the rapid initiation of first-line immunotherapies, specifically intravenous methylprednisolone, intravenous immunoglobulins (IVIG), or plasma exchange, ideally within the first 72 hours of onset. If there is an inadequate response to these initial interventions, management typically escalates within the first week to second-line treatments, which include the ketogenic diet and targeted immunotherapies such as anakinra (an IL-1 antagonist), tocilizumab (an IL-6 antagonist), or rituximab. Despite extensive diagnostic evaluations, including MRI, EEG, and cerebrospinal fluid analysis, approximately 50% of adult cases and nearly all pediatric FIRES cases remain cryptogenic (of unknown cause). Outcomes are frequently unfavorable, with survivors often experiencing long-term functional disability and mortality rates estimated at 12% in children and 16–27% in adults.

This prospective, population-based cohort study focuses on the long-term outcomes of seizures and epilepsy in patients with untreated cerebral cavernous malformations (CCMs). The research tracked 300 patients in Scotland for a median of 15 years to assess the risk of developing seizures and experiencing seizure recurrence without surgical intervention for the CCMs. Key findings include that the risk of a first-ever epileptic seizure from a CCM is low, but the risk of seizure recurrence after a first unprovoked seizure is notably high (80% within 10 years), which justifies the diagnosis of CCM-related epilepsy (CRE). Furthermore, the study found that antiseizure medicine (ASM) significantly reduced the risk of recurrence, and most patients with CRE achieved 2-year and 5-year seizure freedom primarily through medical management. The authors conclude that these long-term data are crucial for informing patients, guiding clinical practice, and highlighting the continued need for randomized controlled trials to compare surgical versus medical management for CRE.

A comprehensive research paper by Laurini et al. (2025) investigating phenotype-genotype correlations in early-onset Charcot-Marie-Tooth type 1B (CMT1B), a neuropathy linked to Myelin Protein Zero (MPZ) variants. The authors analyzed data from a large cohort of 75 Italian patients to understand how different MPZ mutations affect disease severity and progression, categorizing variants as either destabilizing or non-destabilizing. Key findings indicate that destabilizing variants are associated with an earlier onset, more severe clinical features, and a potentially faster rate of progression, which was quantitatively supported by the inverse correlation between predicted protein destabilization ($ΔΔG$ values) and clinical severity scores (CMTES). The study emphasizes that this molecular classification is critical for predicting patient outcomes and informing the development of targeted therapeutic strategies, particularly those aimed at modulating the unfolded protein response (UPR) pathway.

This article focuses on the risk of cardiac disease in a population cohort of individuals with Myotonic Dystrophy Type 1 (DM1) and Type 2 (DM2). This study, conducted by Nicholas E. Johnson et al. using data from the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet), investigated the frequencies of cardiac arrhythmias and cardiomyopathy. The key findings indicate that cardiac arrhythmias are common in the cohort, especially in DM1 patients, and that cardiomyopathy is more prevalent than in the general population. The researchers concluded that serial cardiac monitoring remains necessary for individuals with both DM1 and DM2, particularly since the risk of arrhythmia is significantly higher in DM1, with adult-onset disease also being a risk factor for both arrhythmias and cardiomyopathy. #Neurology #Myotonic Dystrophy

The paper presents a single-center prospective cohort study from Latvia examining the use of the anti-CD20 monoclonal antibody, rituximab, as a treatment for refractory myasthenia gravis (MG). Conducted on nine patients who had failed conventional treatments, the study evaluated the effects of a single low dose over a six-month period. Results indicated significant clinical improvement, marked by a decrease in the Myasthenia Gravis Composite Score (MGCS), and the treatment successfully achieved a steroid-sparing effect, reducing the median daily corticosteroid dose for the cohort. The authors highlight that the therapy was notably safe, reporting no severe adverse reactions or episodes of MG exacerbation requiring intensive rescue treatment. While recognizing the small sample size, the study’s findings reinforce that rituximab is a promising addition to the therapeutic options for managing this challenging autoimmune disorder.

This neurological update details the substantial advancements in treating Myasthenia Gravis (MG), emphasizing transformative developments since 2016. A major focus is the proven efficacy of thymectomy in non-thymomatous disease and the introduction of novel targeted immunotherapies, including complement inhibitors and FcRN inhibitors that actively remove pathogenic antibodies from circulation. Current clinical guidelines are evolving to incorporate these medications for early and aggressive management, acknowledging differing mechanisms and therapeutic responses between AChR-antibody positive and MuSK-antibody positive patient cohorts. The review also examines the impact of demographics, noting the rising incidence of Late-Onset MG (LOMG) and the necessity of tailoring treatment regimens for the aging population. Finally, the authors express optimism regarding future prospects, citing the need for better biomarkers to enable precision medicine and the development of curative approaches like CAR T cell therapy.

The episode summarizes an academic review article from JAMA focusing on Peripheral Neuropathy. This extensive review outlines the condition's importance, including its prevalence and causes, with diabetes being the most common etiology. Furthermore, the article details the condition's pathology, its various clinical presentations, and the diagnostic methods employed for identification. Finally, the text explores different treatment and management options for peripheral neuropathy, especially in cases related to diabetic, nutritional, or other systemic causes.

Diagnostic Controversies in Chronic Inflammatory Demyelinating Polyneuropathy

Two papers, an original article and follow up data from a randomized clinical trial on the use of rituximab for new-onset generalized Myasthenia Gravis (MG) has been reviewed. The studies assess the effectiveness and safety of rituximab over several years, concluding that early exposure to the treatment may offer sustained benefits in disease activity and reduce the need for rescue treatments, despite raising concerns about infection risk.

The episode combines two papers discussing both the potentiyal use of CAR T cells therapy in various autoimmune neurological diseases like Multiple Sclerosis and Myasthenia Gravis, along with potential neurological adverse effects of this treatment.

This article outlines the Active Inference Model, which is one of the proposed pathophysiological mechanisms of functional neurological disorder (FND).