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[Editorial] Universal health coverage: necessary, but not enough

Universal health coverage (UHC) rests on a simple idea: every person, everywhere, should be able to access the health services they need without fear of financial ruin. Across history, societies have recognised that health is a collective responsibility—from paid sick leave in ancient Egypt, to Bismarck's social insurance model in 19th century Germany and the clarion call of the 1978 Alma-Ata Declaration. In 2015, this principle was woven into the Sustainable Development Goals (SDGs), with governments committing to expand service coverage and shield households from catastrophic health spending by 2030.

[Articles] Development and validation of the NEOS2 score for prediction of long-term outcomes and improvement after first-line immunotherapy in patients with anti-NMDAR encephalitis: an international cohort study

The NEOS2-score, readily available at diagnosis and easy to apply, can identify patients with either a favourable or poor prognosis, and those who may benefit from early intensified treatment. The value of the NEOS2-score for guiding treatment decisions and as a stratification tool in studies on optimal treatment regimens, should be confirmed in further prospective studies.

[Health Policy] Building a health system resilience framework: national, state, regional, and local perspectives

Health system resilience (HSR) is essential to sustaining equitable essential functions under acute and chronic stressors in decentralized systems. We developed and validated a Brazil-tailored HSR framework that distinguishes steady-state performance from resilience-specific capacities and assigns responsibilities across federal, state, regional, and municipal levels. Using a three-phase qualitative deductive–inductive approach with 48 international and national experts, we identified nine dimensions, 18 subdimensions, and 65 indicators that prioritise governance coherence, surge workforce strategies, emergency regulation, real-time monitoring, and access to critical technologies.

[Review] Mapping the expressions and impacts of racism on health in Brazil: a scoping review

We conducted a scoping review to examine how racism affects the health of minoritized populations in Brazil. A comprehensive search was carried out, and identified articles underwent independent double screening. The 145 included studies consistently highlighted structural health inequities, with White advantage functioning as a protective factor. Institutional racism restricts healthcare access and availability, exacerbating minoritized populations’ vulnerability to violence and disease through discrimination and substandard care.

[Personal View] The gut microbiome, systemic inflammation, and autoimmunity in Parkinson's disease

Inflammation is a core feature of Parkinson's disease, extending beyond the CNS to include systemic immune activation. The gut microbiome is increasingly recognised as a key regulator of immune function in the gastrointestinal tract, peripheral circulation, and brain. In individuals with Parkinson's disease, gut microbial composition is altered, with reductions in anti-inflammatory taxa and increases in pro-inflammatory bacterial species. Preclinical studies have shown that microbiome alterations can promote α-synuclein aggregation and neuroinflammation, whereas human data suggest early involvement of the gut and immune system.

[Review] The role of lifestyle interventions in symptom management and disease modification in Parkinson's disease

Emerging evidence indicates that sustainable lifestyle changes—such as increasing physical activity, adopting healthy dietary patterns, and managing stress—can provide symptomatic benefits and potentially slow neurodegeneration in Parkinson's disease. Combining these interventions could produce synergistic effects, addressing multiple aspects of the pathophysiology. Despite the challenges of long-term adherence, innovative approaches such as digital tools and personalised strategies can support sustained lifestyle modifications.

[Review] Emerging technologies and strategies in epilepsy surgery: toward personalised medicine

Epilepsy surgery, the treatment of choice for drug-resistant focal epilepsy, is evolving rapidly. This progress is driven by a growing interest in the network theory of epilepsy, advances in data-driven models, and a focus on personalised treatment approaches. As a result, treatment options have expanded to include minimally invasive procedures, neurostimulation devices, and network-based interventions. Predicting surgical outcomes—such as seizure freedom and neuropsychological effects—remains challenging but is improving through advances in computational technology and molecular research, paving the way for more precise surgery.

[Review] Endovascular thrombectomy for acute stroke: evolving eligibility criteria and adjunct therapies

Endovascular thrombectomy is the standard treatment for ischaemic stroke, a leading cause of disability worldwide. Randomised trials in the past decade have expanded eligibility criteria to include broader patient populations, such as those with large ischaemic core stroke. However, many patients still have poor outcomes despite high rates of macrovascular reperfusion, underscoring the need for strategies that go beyond restoring large-vessel flow. Intra-arterial thrombolysis and cytoprotective agents are under investigation for their potential to reduce secondary complications during and after endovascular thrombectomy.

[Articles] Seizure-related biomarkers of sudden unexpected death in epilepsy (SUDEP) in drug-resistant focal epilepsy (REPO2MSE): a prospective, multicentre case–control study

Extratemporal epilepsies involving the perisylvian region or frontal lobe appear to be associated with an increased risk of SUDEP. This finding warrants confirmation in larger cohorts and underscores the need to improve the diagnosis and surgical management of extratemporal epilepsies, which might contribute to improved SUDEP risk stratification and prevention.

[In Context] The structure of thought

What are thoughts? How are thought and language related? These are two of the most fundamental questions regarding the study of the mind, but they have received comparatively little attention compared with questions of consciousness, vision, or memory. However, the field of cognitive linguistics has revealed deeper structures within language that potentially reveal the underlying mechanisms of human thought, and in The Neural Mind, George Lakoff and Srini Narayanan present a theory that links these linguistic structures to underlying mechanisms of thought in a way that is closely based on our understanding of the brain.

[In Context] Migraine as a dynamic continuum during the life course

Traditionally, migraine is defined by the occurrence of cycling episodes of headache and associated neurological symptoms, with a primary focus on the presence of a migraine episode at a specific point in time. However, emerging evidence suggests that migraine is a condition that extends across the life course, encompassing periods of remission, interictal states, and ongoing changes in disease activity. We propose a new perspective that considers migraine states across the life course. This broader view is essential for improving diagnosis, developing patient-centred care models, gaining deeper insights into the underlying pathophysiology, and understanding the interplay between migraine, its risk factors, and comorbidities.

[In Context] Raoul-Michel May, a pioneer in nerve grafting

Raoul-Michel May (1900–68) was born in Mexico to French parents. He earned a PhD in zoology from Harvard University (Cambridge, MA, USA) in 1924. In 1925, he moved to Madrid, Spain, to spend a year working with Santiago Ramón y Cajal (1852–1934), during which time he began translating to English Ramón y Cajal's book Degeneración y Regeneración del Sistema Nervioso.1 Subsequently, May obtained a doctorate in natural sciences in Paris, France, in 1927, studying transplantation of the eye and olfactory organ in frog embryos, and earned his Doctor of Medicine degree in 1939.

[In Context] Julia Greenland

Julia Greenland studied medicine at Newcastle-upon-Tyne, UK, graduating in 2011. Since 2016 she has worked as a specialty registrar in neurology at Addenbrookes Hospital, Cambridge. She completed her PhD in 2024, which explored the role of the immune system in Parkinson's disease. Alongside clinical training as a neurologist, she is a Clinical Research Associate at the University of Cambridge.

[In Context] Takeshi Iwatsubo: a pioneer in Alzheimer's disease research

When he was a medical student at the University of Tokyo in Japan, Takeshi Iwatsubo visited the neuroanatomy laboratory. “I hardly understood anything”, he says, “but I was told to look at human serial brain sections to get an idea about how the human brain is organised. I was invited to visit the lab anytime.” Those visits, he says, were a defining moment in his career. Iwatsubo was a professor of neuropathology at the University of Tokyo until this spring, and is now Director of the National Institute of Neuroscience, at the National Center of Neurology and Psychiatry, where he has a special interest in neurodegenerative disease research, particularly in Alzheimer's disease and Parkinson's disease.

[Corrections] Correction to Lancet Neurol 2025; 24: 413–28

Soliman N, Moisset X, Ferraro MC, et al. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. Lancet Neurol 2025; 24: 413–28—In this Article, the title of the panel on page 423 should read “Drugs or drug classes or neuromodulation treatments for neuropathic pain with inconclusive recommendations or recommendations against use based on the GRADE classification”, and the appendix has been amended. These corrections have been made to the online version as of Dec 10, 2025.