Rethinking Multiple Sclerosis: A New Biologic Framework for MS Progression

Andrew Blumenfeld, MD, Cedars-Sinai Neurology, Los Angeles, CA, discusses the updated American Academy of Neurology and American Headache Society guideline on preventive migraine therapy, including the growing emphasis on shared decision-making, the role of CGRP-targeted therapies, and balancing efficacy with tolerability. He also examines how clinicians can assess meaningful treatment response beyond migraine frequency and explores emerging approaches to prevention, including combination therapies and novel therapeutic targets. Reference: Potrebic S, Tanveer S, Becker WJ, et al. Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations: Report of the AAN Guidelines Subcommittee and the American Headache Society. Headache. 2026;66(9):2173-2184. doi:10.1111/head.70199

Daniel Ontaneda, MD, PhD, Cleveland Clinic, Cleveland, OH, explains why traditional labels such as relapsing-remitting, secondary progressive, and primary progressive multiple sclerosis (MS) may not fully reflect the underlying biology of the disease and why a more dynamic framework could better capture how MS changes over time.

Hubert Fernandez, MD, Cleveland Clinic, Cleveland, OH, discusses findings from the TEMPO trials evaluating tavapadon, a selective dopamine D1/D5 receptor partial agonist, as monotherapy in early Parkinson disease and as an adjunct to levodopa in patients with motor fluctuations. He examines efficacy, tolerability, adverse events, and where tavapadon could fit within the evolving Parkinson disease treatment landscape.

In this episode, Patrick J. Strollo Jr, MD, FACP, FCCP, FAASM, of the University of Pittsburgh Department of Medicine, Pittsburgh, PA, discusses the data from the phase 3 SynAIRgy clinical trial for AD109, an investigational once-nightly oral treatment targeting neuromuscular dysfunction in obstructive sleep apnea, and its potential role in a more personalized approach to OSA care.

This episode explores the real-world implementation of the Davos Alzheimer’s Collaborative Healthcare System Preparedness (DAC-SP) US Early Detection Program at Virtua Health, examining outcomes in identifying cognitive impairment, streamlining referrals, and supporting efficient use of clinical resources. Elyse Perweiler, RN, MPP, Professor, Rowan–Virtua School of Osteopathic Medicine, Stratford, NJ, and Tim MacLeod, PhD, Executive Director, Healthcare System Preparedness Program, DAC, Toronto, Ontario, Canada, return for part 2 of this 3 part series.

Elyse Perweiler, RN, MPP, Professor, Rowan–Virtua School of Osteopathic Medicine, Stratford, NJ, and Tim MacLeod, PhD, Program Director, Healthcare System Preparedness Program, Davos Alzheimer’s Collaborative (DAC), Toronto, Ontario, Canada, examine how health systems can operationalize early cognitive screening to better prepare patients for specialty evaluation. Learn how standardized workflows, digital cognitive tools, and primary care–neurology collaboration can enhance diagnostic efficiency and access to Alzheimer disease care.

This episode explores new evidence showing that paramagnetic rim lesions (PRLs) are highly prevalent early in multiple sclerosis (MS) and can differentiate MS from mimics with striking accuracy. Dr. Daniel Ontaneda, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, and Dr. Pascal Sati, Cedars-Sinai Medical Center,  Los Angeles, CA, discuss how PRLs, paired with optimized susceptibility-based MRI, are reshaping diagnostic confidence and informing the latest revisions to the McDonald criteria.

Patrick Y. Wen, MD, Dana-Farber Cancer Institute, Boston, MA, discusses current standards of care for low- and high-grade gliomas, including the importance of comprehensive molecular testing, the World Health Organization classification of tumors of the central nervous system, and newly available therapies.

Hope O’Brien, MD, MBA, FAHS, FAAN, Founder and CEO of the Headache Center of Hope, Cincinnati, OH, discusses challenges and considerations for adult headache neurologists who are onboarding adolescent patients as they transition from pediatric practice. Dr. O’Brien highlights a framework with strategies for a seamless transition, while noting best practices for promoting patient autonomy and mental wellbeing.

Merit Cudkowicz, MD, Julieanne Professor of Neurology, Harvard Medical School, Boston, MA, discusses the evolving landscape of treatment for ALS, including FDA-approved disease-modifying therapies, the importance of genetic testing, the emergence of gene therapies, and the promising clinical trial pipeline targeting genetic and sporadic forms of ALS.