A Roadmap to Neurological Health Equity - Part 2

In part two of this series, Dr. Tesha Monteith and Dr. Nimish A. Mohile discuss the motivation behind the development of this roadmap to neurological health equity.  Show citation:  Patel PB, Hamilton RH, Budhu JA, et al. A Roadmap to Neurologic Health Equity: An AAN Position Statement. Neurology. 2026;106(5):e214687. doi:10.1212/WNL.0000000000214687 

In the first part of this series, Dr. Tesha Monteith and Dr. Nimish A. Mohile discuss what the roadmap is and how it is intended to benefit practicing neurologists. Show citation:  Patel PB, Hamilton RH, Budhu JA, et al. A Roadmap to Neurologic Health Equity: An AAN Position Statement. Neurology. 2026;106(5):e214687. doi:10.1212/WNL.0000000000214687   

Dr. Greg Cooper and Dr. Sara Hassani discuss periprocedural brain health and call on neurologists to engage in multidisciplinary efforts to improve periprocedural outcomes. Show citation: Hassani S, Gorelick PB. Periprocedural Brain Health: The Scope of the Problem and the Neurologist's Role. Neurology. 2025;105(12):e214427. doi:10.1212/WNL.0000000000214427   Show transcript: Dr. Greg Cooper: Hi, this is Greg Cooper. I just finished interviewing Sara Hassani for this week's Neurology Podcast. For today's Neurology minutes, Sara, I'm hoping you can tell us the main points of your paper. Dr. Sara Hassani:  I would say that the central message of this paper is that paraprocedural neurologic complications, they're very common, and they may actually be as high as the third leading cause of mortality, and yet very few healthcare providers realize this. And furthermore, few healthcare providers are adequately prepared to discuss the risks of the various procedures with patients and/or their family members. Dr. Greg Cooper: Thank you for that summary and all your work on this topic. Please check out this week's podcast to hear the full interview, and read the full article published in Neurology, Paraprocedural Brain Health. Thank you. 

Dr. Paul Crane and Dr. Hanalise Huff discuss neurological and neurocognitive sequelae in pediatric survivors of the 2015 Ebola outbreak in Liberia.  Show citation:  Huff HV, Van Ryn C, Reilly C, et al. Neurologic Sequelae After Ebola Virus Disease in Children in Liberia: An Observational Study. Neurology. 2026;106(1):e214450. doi:10.1212/WNL.0000000000214450 

In this lab update, Dr. Stacey Clardy focuses on micronutrient screening. 

In this lab update, Dr. Stacey Clardy discusses the latest information on chronic wasting disease. 

In part two of this series, Dr. Aaron Zelikovich discusses the clinical implications for patients with HSV encephalitis.  Show citation:  Solomon T, Hooper C, Easton A, et al. Safety and efficacy of adjunct dexamethasone in adults with herpes simplex virus encephalitis in the UK (DexEnceph): a multicentre, observer-blind, randomised, phase 3, controlled trial. Lancet Neurol. 2026;25(2):136-146. doi:10.1016/S1474-4422(25)00454-5 

Dr. Greg Cooper and Dr. Kerry Sheets discuss how hearing aid use affects cognition and the risk of dementia in older adults with hearing impairment.  Show citations: Cribb L, Moreno-Betancur M, Pase MP, et al. Treating Hearing Loss With Hearing Aids for the Prevention of Cognitive Decline and Dementia. Neurology. 2026;106(3):e214572. doi:10.1212/WNL.0000000000214572  Show transcript: Dr. Greg Cooper: Hi, this is Greg Cooper. I just finished interviewing Kerry Sheets for this week's Neurology Podcast. For today's Neurology Minute, I'm hoping you can tell us the main points of your paper. Dr. Kerry Sheets: The central message of our paper is that hearing aid use in adults aged 70 years or older with hearing impairment may reduce dementia risk over 7 years. Results for the impact of hearing aid use on cognitive decline were less. Dr. Greg Cooper: Well, thank you for that summary and for all of your work on this topic. Please check out this week's podcast to hear the full interview and read the full article published in Neurology: Treating Hearing Loss with Hearing Aids for the Prevention of Cognitive Decline and Dementia. 

Dr. Jessica Ailani and Dr. Richard Lipton discuss future advancements in headache medicine.  Show transcript:  Dr. Jessica Ailani:  Hello and welcome to the Neurology Minute. I'm Jessica Ilani from Georgetown Headache Center in Washington, DC. In the neurology podcast with Richard Lipton from the Montefiore Headache Center, we'll be discussing the latest clinical trials in headache medicine, where our field is going, where it's been, and you'll get lots of great advice on thinking through a clinical trial, what the advances have been, where their pitfalls have been, and really how to think of both positive and negative trials. So Richard, what are you most looking forward to when it comes to new treatment targets within headache? Dr. Richard Lipton:  First, let me say that I'm sure most know about the eight CGRP targeted treatments have been approved for migraine, both as acute and preventive treatments. And it's very clear that those treatments have had incredible benefits for our patients and have really improved headache practice. There's another neuropeptide target also targeted by monoclonal antibodies called PACAP or pituitary adenolyte cyclase activating polypeptide. This peptide is also a potent vasodilator involved in pain signaling like CGRP. While CGRP is primarily linked to sensory pathways, PACAP is found in parasympathetic ganglia. And for that reason, it may have a special role in headaches associated with cranial autonomic symptoms. And that includes both migraine, which commonly has cranial autonomic symptoms and also cluster headache. There's a recent randomized trial published in New England Journal showing that a monoclonal antibody targeting PACAP reduced monthly migraine day frequency and was beneficial in people who failed to respond to CGRP inhibitors. So that's at least one area that I'm hopeful about. Dr. Jessica Ailani:  So Richard, thank you so much. I hope you have a few moments and listen to our full podcast that'll tell you a lot more about the future of headache medicine. 

In part one of this series, Dr. Aaron Zelikovich discusses the trial design and primary results.  Show citation:  Solomon T, Hooper C, Easton A, et al. Safety and efficacy of adjunct dexamethasone in adults with herpes simplex virus encephalitis in the UK (DexEnceph): a multicentre, observer-blind, randomised, phase 3, controlled trial. Lancet Neurol. 2026;25(2):136-146. doi:10.1016/S1474-4422(25)00454-5  Show transcript:  Dr. Aaron Zelikovich:  Welcome to today's Neurology Minute. My name is Aaron Zelikovich. I'm a neuromuscular specialist at Lenox Hill Hospital in New York City. Today, we'll discuss part one of a three-part series reviewing a recent article titled Safety and Efficacy of Adjunct Dexamethasone in Adults with Herpes Simplex Virus Encephalitis in the United Kingdom (DexEnceph) Study, a multicenter observer-blind randomized phase three control trial published in Lancet Neurology. In the first episode, we'll focus on the trial design and primary results. In part two, we'll discuss the clinical implications for patients with HSV encephalitis, and in part three, discuss the outcomes seen across the trial during and after an acute infection. Overall, the study found that adjunct dexamethasone did not improve outcomes in patients with CSF-confirmed HSV encephalitis. But importantly, it also did not worsen outcomes. Prior research that was non-randomized and retrospective of 45 patients with HSV encephalitis found that patients did not receive corticosteroids had worse outcomes. A different randomized trial looking at dexamethasone and HSV encephalitis was only able to recruit 41 patients and was stopped prematurely due to the lack of recruitment. Prior to the study, there was no clear evidence that adjunct steroids with acyclovir improved outcomes in HSV encephalitis. The Dex and phase three randomized clinical trial performed in the United Kingdom at 53 hospitals recruited patients from 2016 to 2022. They screened over 1,400 patients of which only 94, or 6%, were enrolled. Patients were randomized to either acyclovir only or acyclovir and intravenous dexamethasone. In order to be randomized, patients had to have a febrile illness with new onset seizure or new focal neurological sign or altered mental status as well as a positive HSV type one or two PCR from the CSF. The primary outcome for this study was the Wechsler Memory Scale Type Four Auditory Memory Index Score which was collected at 26 weeks. It had a range of 40, which is the worst outcome, to a range of 160 which was considered normal. 81 patients were included in the modified intention-to-treat analysis. Of the 13 patients, six were lost to follow-up, and seven withdrew consent. There were 39 patients in the dexamethasone group and 42 in the acyclovir-only group in the final analysis. The primary outcome of the Wechsler Memory Scale had similar scores in both groups. 71 in the dexamethasone group and 69 in the control group with a P value of 0.76. The safety profile was similar in both groups, and there were no additional safety signals found in the dexamethasone-treated group. At 26 weeks, there were 12 deaths from HSV encephalitis, six from each group, as well as a similar time to discharge between both cohorts. The DexEnceph clinical trial did not show any clear clinical benefit for dexamethasone with regards to clinical outcomes but also didn't show any increased safety concerns compared to only acyclovir. In part two, we will discuss the implications of this trial in patients with undifferentiated encephalitis and the role that steroids play in patients that HSV encephalitis is suspected. Thank you so much, and have a wonderful day.