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[In Context] Stéphanie Debette: a neurologist with a passion for the arts

Stéphanie Debette, a French neurologist and epidemiologist, had one condition before she would accept her appointment as Executive Director of the Paris Brain Institute in January 2025: she wanted to continue the research she had been pursuing, most recently as founding director of the Vascular Brain Health Institute in Bordeaux. She told the hiring committee: “I have always insisted on keeping my research activity, especially as it is embedded in a number of international consortia”. Her appointment followed her being awarded the Inserm Grand Prix, the most prestigious annual award for biomedical research in France, and her induction into the French Academy of Sciences, both in 2024.

[Corrections] Correction to Lancet Neurol 2025; 24: 880–92

Saidha S, Green AJ, Leocani L, et al. The use of optical coherence tomography and visual evoked potentials in the 2024 McDonald diagnostic criteria for multiple sclerosis. Lancet Neurol 2025; 24: 880–92—For this Personal View, the International Multiple Sclerosis Visual System consortium should have been included in the authorship line, and a list of consortium members are included in the appendix. These corrections have been made to the online version as of Sept 18, 2025.

[Corrections] Correction to Lancet Neurol 2025; 24: 850–65

Montalban X, Lebrun-Frénay C, Oh J, et al. Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria Lancet Neurol 2025; 24: 850–65—In this Position Paper, figures 2 and 3 have been swapped so that figure 2 is now: “Diagnostic algorithm for radiologically isolated syndrome and other non-specific presentations” and figure 3 is now: “Diagnostic algorithm for relapsing and progressive presentations of multiple sclerosis”. These corrections have been made to the online version as of Sept 23, 2025.

[Comment] Multidomain lifestyle interventions for cognitive function

The burden of cognitive decline is growing, affecting many people worldwide and placing a substantial strain on health-care systems.1 As such, effective interventions to slow down, prevent, or reverse cognitive decline are of utmost importance. Cognitive decline is affected by various lifestyle factors, and consequently, multidomain interventions (eg, encouraging physical activity, healthy diet, social engagement, and physical health monitoring) likely lead to the best outcomes.2

[Comment] Promises, hopes, and dreams in Parkinson's disease research

Since James Parkinson first described his eponymous disease, our knowledge of its pathophysiology has grown enormously. However, in clinical settings, many of the original concepts remain in use, and diagnosis is still focused on the motor features arising due to the loss of dopaminergic neurons in the substantia nigra. Although these concepts have been useful for the field, enabling the development of a panoply of highly efficacious symptomatic therapies, they might have also hindered the development of disease modifying therapies, which require a deep understanding of the underlying biology.

[Comment] Probing our understanding of intracranial aneurysms

Intracranial aneurysms are detected in about 3% of adults who undergo brain vascular imaging.1,2 About 7 million people in the US alone have an intracranial aneurysm, which are being detected more frequently due to the increasing use and sensitivity of brain vascular imaging. The most important manifestation of an intracranial aneurysm is subarachnoid haemorrhage, but its incidence is only 6 per 100 000 population per year.3 This discrepancy between the prevalence of intracranial aneurysms and the incidence of subarachnoid haemorrhage means that most intracranial aneurysms never rupture.

[Comment] Neuropathology of Alzheimer's disease after anti-amyloid β antibody treatment

Treatment with anti-amyloid β antibodies is becoming standard therapy for early Alzheimer's disease, as lecanemab and donanemab received full approval in the USA, Japan, and other countries between 2023 and 2024. However, only about ten autopsy cases involving passive immunisation with these treatments have been reported so far. These reports include three cases involving aducanumab treatment;1,2 two cases after lecanemab treatment that experienced severe amyloid-related imaging abnormalities (ARIA),3,4 an adverse event specific to this therapy; one case of lecanemab treatment without ARIA;5 and four cases of gantenerumab or solanezumab treatment from the Dominantly Inherited Alzheimer Network Trials Unit (DIAN-TU; table).

[Comment] Predicting stroke risk in women: are inflammation and atherosclerosis enough?

Stroke risk evolves across the lifespan, with distinct sex-specific differences that remain underappreciated in both research and clinical practice.1 One of these differences is the higher incidence of ischaemic stroke in women younger than 35 years compared with men of the same age, attributed to reproductive and hormonal factors such as oestrogen exposure, pregnancy complications, and, possibly, migraine with aura.2 In contrast, men's stroke risk accelerates more rapidly in midlife, whereas in older age (typically 75 years and older), the risk in women again surpasses that in men—driven by longer life expectancy and a higher prevalence of specific risk factors, such as atrial fibrillation.

[Comment] Treatment of acute central retinal artery occlusion: light at the end of the tunnel?

The acute management of central retinal artery occlusion (CRAO) has shifted from eye-care providers (eg, optometrists and ophthalmologists) to stroke neurologists, with emphasis on hyperacute management, expedited diagnostic tests, and aggressive secondary prevention.1,2 Revascularisation of the ischaemic retina with thrombolysis is supported by anecdotal cases, open-label studies, and meta-analyses of observational data, suggesting that intravenous thrombolysis is a low-risk therapy in patients with acute CRAO.

[Editorial] Essential medicines for neurological disorders: updates, rejections, and the road ahead

Several updates relevant to neurologists and health-care professionals involved in the prevention and treatment of neurological diseases have been added to the WHO Model List of Essential Medicines (EML). The inclusion of drugs into “the world's most influential list of medicines” is a necessary step towards equitable access. WHO's aspiration is for most countries to have access to all essential medicines for neurological disorders by 2031, and more drugs need to be added to the list in upcoming revisions if this goal is to be fulfilled.

[Clinical Picture] Coronary polyarteritis nodosa

A 36-year-old woman had dyspnoea on exertion with intermittent chest tightness that occurred during and outside of exertion. She did not disclose any systemic diseases and there was no family history of cardiovascular or pulmonary conditions. An electrocardiogram done during a treadmill test showed ST segment depression without atypical serum concentrations of creatinine kinase or troponin I. A coronary CT angiography showed a so-called rosary-bead appearance and luminal irregularity with ectatic changes over the coronary arteries (figure A–C).

[Review] Synovial immunopathology in psoriatic arthritis: cellular and molecular insights

Although psoriatic arthritis and rheumatoid arthritis are both common types of inflammatory arthritis characterised by synovial inflammation, there are distinct molecular and cellular landscapes between these conditions. Recent advances in synovial research in psoriatic arthritis have begun to unlock important insights into disease pathogenesis and potential clinical applications. For example, studies using high-dimensional technologies have identified psoriatic arthritis-specific macrophage, fibroblast, and mast cell subsets, as well as specific cytokines, such as IL-36 and IL-41, that drive pathogenesis.

[Articles] Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): 3-year follow-up of a randomised, controlled trial

Treatment sessions of CFT produced sustained effects at 3 years for people with chronic disabling low back pain. These long-term effects are novel and provide the opportunity to markedly reduce the effect of chronic back pain if the intervention can be widely implemented. Implementation requires scaling up of clinician training to increase accessibility and replication studies in diverse health-care systems.

[Articles] Effect of a treatment strategy utilising golimumab, methotrexate and corticosteroids versus methotrexate and corticosteroids in early, untreated psoriatic arthritis (GOLMePsA): a single-centre, double-blind, parallel-group, randomised controlled trial

Both interventions led to improved disease activity in patients with early, untreated psoriatic arthritis, without a clinically or statistically significant difference in PASDAS between treatment groups at week 24. Participants in the placebo and methotrexate group required more rescue corticosteroids. Sustained results were observed at week 52 in both groups, without serious or unexpected adverse events.

[Insights] Sharon Dowell: specialised treatment for the many

Sharon Dowell, a native of Barbados, had wanted a medical career since age 12, when her uncle was diagnosed with brain cancer. He ultimately succumbed to the cancer, but she had lasting memories of the doctors, who impressed her as “confident” and “knowledgeable” at a time when she and her family did not know what to do. “They brought hope”, she remembers. “I wanted to be able to do that for my family, for my mom, who seemed so lost and uncertain.” Dowell would later attend medical school at the University of the West Indies (Kingston, Jamaica).