Neurology Minute

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.

In the second part of this series, Dr. Tesha Monteith and Dr. Jennifer Robblee discuss updates to the emergency room recommendations for the acute treatment of migraines. Show citations: Robblee J, Minen MT, Friedman BW, Cortel-LeBlanc MA, Cortel-LeBlanc A, Orr SL. 2025 Guideline Update to Acute Treatment of Migraine for Adults in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache. 2026;66(1):53-76. doi:10.1111/head.70016 Robblee J, Khan FA, Marmura MJ, et al. Reaching International Consensus on the Definition of Refractory Migraine Using the Delphi Method. Cephalalgia. 2025;45(9):3331024251367767. doi:10.1177/03331024251367767 Show transcript: Dr. Tesha Monteith: Hi, this is Tesha Monteith with the Neurology Minute. I've just been speaking with Jennifer Robblee about her exciting work, defining refractory migraine with an international consensus, as well as her work with the American Headache Society on a guideline update for parental pharmacotherapies for migraine in the emergency department. So Jennifer, we've just been chatting on the podcast about all the great work out of the American Headache Society, updating the emergency room recommendations for acute treatment of migraine. Can you give a summary of those findings? Dr. Jennifer Robblee: We looked at all of the new data for randomized control trials in the emergency room. We found 26 new trials, and several of those were actually a class one study that we felt had a low risk of bias. And from that, we applied the grading. So we actually have two grade A medications where it is that you must offer, of course, to the appropriate patient. And that's prochlorperazine IV, and greater occipital nerve blocks. Now, there's also a grade A must not offer, and that's IV hydromorphone. Then we have some grade B, which is should offer, and that's dexketoprofen, ketorolac, metaclopramide, sumatriptan subcutaneous, and supraorbital nerve blocks. So really exciting that we have lots of things that we can now say we have pretty good evidence or very good evidence to offer them to our patients. Dr. Tesha Monteith: Great. It's always nice to see this update based on evidence. Dr. Jennifer Robblee: Yes, I think it's so important, because right now when we see patients, and I'm sure you get this all the time, they come back, say they were in the emergency room for a severe headache and they got a migraine cocktail. And you're like, "Do you know what you were given?" And they say, "I don't know. I was just told it's a migraine cocktail." And as you know, that mean many, many different things. And when you are able to pull the records, it is many, many different things that a migraine cocktail can mean. So I'm hoping that this can start to standardize what we're actually giving our patients as we await more trials in the future that might start to tell us what that combo of treatments really should be. For right now, these at least tell us what individual treatments have the best evidence. Dr. Tesha Monteith: Thanks so much, Jennifer.

A concise rundown of 2026 advocacy priorities on access to care, including drug pricing proposals and telehealth permanence. A look at efforts to reduce administrative burdens like prior authorization and step therapy. Discussion of neurology workforce concerns, Medicare reimbursement and immigration for international trainees. An overview of threats to neuroscience research funding and advocacy for NIH/NINDS support.

Abel Sandmann, clinical researcher at Amsterdam UMC studying cerebrovascular malformations and epilepsy. He discusses when a first unprovoked seizure with a cerebral cavernous malformation meets criteria for epilepsy. He reviews low 10-year risk for first seizures in incidental CCMs. He highlights the high recurrence risk after a first seizure and how medical therapy often achieves long-term seizure freedom.

Jennifer Robblee, a physician specializing in refractory migraine research and guideline development, discusses why a standardized international definition for refractory migraine was needed. She walks through the consensus structure and key criteria. She also previews updated guidance for acute migraine treatment in the emergency department.

A concise look at two biotin problems: rare true deficiency causing neurologic signs in adults and dangerous newborn biotinidase deficiency. A warning about widespread high-dose biotin supplements that quietly spoil lab tests. Practical tips on which tests are commonly misleading and when to recheck after stopping supplements.

In this episode, Dr. Stacey Clardy reviews the February 23rd Capitol Hill Report, recapping key takeaways from Neurology on the Hill. Stay updated with what's happening on the hill by visiting aan.com/chr. Learn how you can get involved with AAN advocacy. Show transcript: Dr. Stacey Clardy: Hi, this is Stacey Clardy with today's Neurology Minute. It's an advocacy update from the AAN's Capitol Hill Report. More than 200 AAN members came to Washington, DC, last week for the AAN's annual advocacy fly-in, Neurology on the Hill. As you probably know, this is the annual chance for neurologists to get some face-to-face time with members of Congress or their aides in the US right on Capitol Hill. AAN members had three asks for this year's event. We did cover them last week individually on the Neurology Minute, so have a listen if you want more detail, but I'll review them quickly. First, we asked for a permanent inflationary update to physician reimbursement based on the Medicare Economic Index and to raise the outdated budget neutrality triggers in the Medicare physician fee schedule. Under the current system, the AAN needs to ask Congress nearly every year to fix a proposed cut to physician payment under Medicare, so it's time for a better solution. The second ask, AAN members requested their legislators to co-sponsor the Connect for Health Act in the US. This legislation would support patient access to care by making those old COVID era telehealth flexibilities now permanent rather than requiring repeated extensions. And the need to make these flexibilities permanent was especially clear in the US during the 2025 government shutdown when Medicare recipients' access to telehealth lapsed for about 45 days. And finally, the third ask was for the BRAIN Initiative at the National Institutes of Health, it's a very important program funding basic research into the brain and it's losing a key funding stream that was previously provided through the 21st Century Cures Act, so the AAN members asked their legislators to close the gap by supporting $468 million in funding for the BRAIN Initiative in 2027. If you didn't go to Neurology on the Hill but want to support these causes, check the AAN's Advocacy Action Center, and you could contact your representative that way. Outside of DC news, a number of state legislators are considering bills that positively or negatively affect neurology. The AAN has weighed in on several of those bills with advocacy letters. The bills it supported include later school start times in Pennsylvania, restricting AI prior authorization denials in Florida and Hawaii, mandating coverage for telehealth services in Massachusetts, and reducing prior authorization burdens in Arizona and Kansas. The AAN opposed a New York bill, however, that would give chiropractors the ability to evaluate and diagnose neuromusculoskeletal conditions and provide consultation advice and recommendations on neurology. So you can find links and more in the Capitol Hill Report. It's available on aan.com/CHR, that's short for Capitol Hill Report, and in US members' email inboxes. That's it for this time. Thanks. I'm Stacey Clardy for The Minute.

In the March episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost share key updates and strategic insights for the upcoming April meeting in Chicago. Stay informed by watching the President's Spotlight video. Show transcript: Dr. Jason Crowell: Hey, this is Jason Crowell. Thanks for listening to today's Neurology Minute. Once again, this month, we have Natalia Rost joining us, the president of the AAN for her presidential spotlight. Natalia, the sun is starting to come out. The flowers are starting to bloom. Spring is here. What is going on with the academy? What would you like to tell us about this month? Dr. Natalia Rost: These are exciting times indeed. Our annual meeting is just one month away. And so I'm looking forward to all of us coming together to learn, share ideas, and to connect. And this year, the world's largest neurology event is even larger. And I like to say it's my meeting of 15,000 friends. Dr. Jason Crowell: Terrific. For those who are listening today who haven't heard about the annual meeting, what would you like for them to know about it? Dr. Natalia Rost: Well, so the meeting takes place April 18th through 22nd in Chicago and online. And like so many, I love Chicago. It's a world-class city. It's a major travel hub and making it easy for many of us to attend. And we're expecting presentations of more than 3,500 abstracts. It's a new record for our meeting. Registration is also trending ahead of previous years, so now is the time to make your plans. Dr. Jason Crowell: And what would you say are the three things that you look forward to the most every year at the meeting? Dr. Natalia Rost: Well, first of all, the Sunday of this meeting, April 19th, is our research day, which will focus on advancing neuroscience and the AAN's renewed commitment to research funding we talked about last month. It includes my presidential plenary, which is titled Neuroscience at the Crossroads, and which will feature interactive panels of seasoned neuroscience leaders and clinician scientists who are right in the midst of their exciting careers. We will have our research hub to take part in many opportunities to support our high quality research program, so that's going to be great. Another highlight is a celebration of the extraordinary accomplishments of Dr. Walter Koroshetz, the immediate past NINDS director, and a phenomenal neurologist who is our 2026 President's Award winner and who will join us at the Presidential Plenary. This is going to be a very special and spirited event. And also, I'm excited to debut the new Brain Hub this year. I hope folks will stop by. Along with that, we have a special museum exhibit and reception for the Neurology Journal's 75th anniversary. I sure will be stopping by both. Dr. Jason Crowell: I would say that people in the world of medicine often misunderestimate just how much fun neurologists can be. What fun is planned for the annual meeting this year? Dr. Natalia Rost: Oh yeah, we're on it. As always, we will have our celebrated annual meeting party on Sunday night. This year, the entire Griffin Museum of Science and Industry will be hours to explore while you enjoy your food, drinks, and conversation with colleagues. Dr. Jason Crowell: And for our listeners, where can they learn more about the annual meeting and all the details? Dr. Natalia Rost: Please register now at aan.com/am. This is an annual meeting you won't want to miss, so join me with everything neurology premier event has to offer. Dr. Jason Crowell: Terrific. Natalia, thanks so much. Looking forward to Chicago.