From “Diagnose and Adiós” to Brain Health: Are We There Yet?

Augusto Miravalle, MD, FAAN

“DIAGNOSE AND ADIÓS” 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 expanded 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 having different options with various degrees of clinical efficacy, the traditional model of escalation therapies, in which low-efficacy treatments were used early in the course of the disease, is being replaced by an early, highly effective therapy approach. Anti–B-cell therapies are being recognized among the most effective strategies to address 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 a review 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 summary of recent advances in the treatment armamentarium of amyotrophic lateral sclerosis.

Overcoming an early reputation of a cognitive specialty with limited treatments for our patients, neurology has evolved considerably in the past 20 years with advances in neuroimaging, therapeutics, biomarkers, and genomics. Moreover, the field of neurology is going beyond merely treating neurological disorders and is beginning to understand how to prevent the development of neurodegeneration and use nonpharmacological approaches to maximize brain health. As a 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 outlining objectives and tactics to incorporate brain health into neurological practice. In this issue of NeurologyLive^®, Jordan Acosta, MS, and Brett Fling, PhD, MS, elegantly outline recent advances in our understanding of how exercise impacts overall brain health and influences disease progression in MS.

One in 6 individuals in the United States is affected by brain disease, including stroke, Alzheimer disease, MS, migraine, and Parkinson disease. The quest of achieving ideal brain health in our communities is far from being accomplished; however, an exciting shift of our approach to the management of neurological conditions resulting in a newly evolving field of brain health.

REFERENCE
1. Moreno-Zambrano D, Sandrone S, Meza-Venegas J, et al. Exploring the key factors behind neurophobia: a systematic review of the English, Spanish and Portuguese literature. Brain Disorders.