Pub Date : 2025-09-17DOI: 10.1038/s41582-025-01144-0
Helen Tremlett
The multiple sclerosis (MS) prodrome and radiologically isolated syndrome (RIS) form overlapping parts of the MS disease continuum. The 2024 revisions of the McDonald criteria for diagnosis of MS now enable diagnosis in some individuals with RIS, emphasizing the value placed on recognizing the earliest manifestations of MS and providing a new opportunity to advance understanding of the prodromal phase. Updates to the McDonald criteria for diagnosis of multiple sclerosis emphasize the value placed on recognizing the earliest manifestations of multiple sclerosis, providing new opportunity to advance understanding of the prodromal phase.
{"title":"The multiple sclerosis prodrome: insights into how and when disease starts","authors":"Helen Tremlett","doi":"10.1038/s41582-025-01144-0","DOIUrl":"10.1038/s41582-025-01144-0","url":null,"abstract":"The multiple sclerosis (MS) prodrome and radiologically isolated syndrome (RIS) form overlapping parts of the MS disease continuum. The 2024 revisions of the McDonald criteria for diagnosis of MS now enable diagnosis in some individuals with RIS, emphasizing the value placed on recognizing the earliest manifestations of MS and providing a new opportunity to advance understanding of the prodromal phase. Updates to the McDonald criteria for diagnosis of multiple sclerosis emphasize the value placed on recognizing the earliest manifestations of multiple sclerosis, providing new opportunity to advance understanding of the prodromal phase.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 12","pages":"661-663"},"PeriodicalIF":33.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1038/s41582-025-01140-4
Andrew J. Solomon, John B. Brodersen
The 2024 revisions of the McDonald criteria for multiple sclerosis for the first time permit diagnosis in asymptomatic people with MRI findings suggestive of multiple sclerosis pathology. Although these changes promise opportunities for earlier treatment and improved clinical outcomes, they present a new risk in the form of overdiagnosis.
{"title":"The 2024 revisions of the McDonald criteria pose risk of multiple sclerosis overdiagnosis","authors":"Andrew J. Solomon, John B. Brodersen","doi":"10.1038/s41582-025-01140-4","DOIUrl":"10.1038/s41582-025-01140-4","url":null,"abstract":"The 2024 revisions of the McDonald criteria for multiple sclerosis for the first time permit diagnosis in asymptomatic people with MRI findings suggestive of multiple sclerosis pathology. Although these changes promise opportunities for earlier treatment and improved clinical outcomes, they present a new risk in the form of overdiagnosis.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 12","pages":"659-660"},"PeriodicalIF":33.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1038/s41582-025-01141-3
Marcello Moccia, Olga Ciccarelli, Alan Thompson
The 2024 revision of the McDonald criteria for diagnosis of multiple sclerosis marks a substantial departure from previous iterations, establishing a unified framework that integrates presentation, lesion topography and a flexible combination of paraclinical tools. This Clinical Outlook considers the major changes and their clinical implementation, and the implications of the new criteria.
{"title":"Implementation of the 2024 revision of the McDonald criteria for multiple sclerosis","authors":"Marcello Moccia, Olga Ciccarelli, Alan Thompson","doi":"10.1038/s41582-025-01141-3","DOIUrl":"10.1038/s41582-025-01141-3","url":null,"abstract":"The 2024 revision of the McDonald criteria for diagnosis of multiple sclerosis marks a substantial departure from previous iterations, establishing a unified framework that integrates presentation, lesion topography and a flexible combination of paraclinical tools. This Clinical Outlook considers the major changes and their clinical implementation, and the implications of the new criteria.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 12","pages":"664-666"},"PeriodicalIF":33.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1038/s41582-025-01137-z
Irena Rektorová, Monika Pupíková, Lisa Fleury, Luboš Brabenec, Friedhelm C. Hummel
Device-based non-invasive brain stimulation (NIBS) techniques show promise for the treatment of neurological and psychiatric disorders, although inconsistencies in protocol designs and study findings can make the field difficult to navigate. In this Review, we discuss applications of NIBS for enhancing cognitive and motor function in people with various neurological diseases that are characterized by disruption of large-scale brain networks, including neurodegenerative diseases and brain lesion disorders such as stroke and traumatic brain injury. In particular, we focus on repetitive transcranial magnetic stimulation and transcranial electrical stimulation, as these techniques have been widely used in clinical settings and randomized controlled trials. We summarize and synthesize current knowledge, and highlight gaps and shortcomings in the existing research that make it difficult to draw firm conclusions, including small sample sizes, heterogeneous patient populations and variations in stimulation protocols. We believe that a rapid evolution of NIBS techniques from state-dependent, network-informed, multifocal and subcortical paradigms to individualized electric field modelling and accelerated NIBS protocols will improve the management of neurological disorders. However, realizing this potential will require us to address crucial challenges and acquire deeper mechanistic insights, with the aim of developing adaptive, biomarker-driven protocols to optimize target engagement, dosing and timing for each patient. Non-invasive brain stimulation (NIBS) shows considerable promise as a therapeutic strategy for neurological and psychiatric disorders. This Review explores the role of NIBS techniques, including repetitive transcranial magnetic stimulation and transcranial electrical stimulation, for treating cognitive impairments, speech and language difficulties, and motor control deficits in people with neurodegenerative or brain lesion disorders.
{"title":"Non-invasive brain stimulation: current and future applications in neurology","authors":"Irena Rektorová, Monika Pupíková, Lisa Fleury, Luboš Brabenec, Friedhelm C. Hummel","doi":"10.1038/s41582-025-01137-z","DOIUrl":"10.1038/s41582-025-01137-z","url":null,"abstract":"Device-based non-invasive brain stimulation (NIBS) techniques show promise for the treatment of neurological and psychiatric disorders, although inconsistencies in protocol designs and study findings can make the field difficult to navigate. In this Review, we discuss applications of NIBS for enhancing cognitive and motor function in people with various neurological diseases that are characterized by disruption of large-scale brain networks, including neurodegenerative diseases and brain lesion disorders such as stroke and traumatic brain injury. In particular, we focus on repetitive transcranial magnetic stimulation and transcranial electrical stimulation, as these techniques have been widely used in clinical settings and randomized controlled trials. We summarize and synthesize current knowledge, and highlight gaps and shortcomings in the existing research that make it difficult to draw firm conclusions, including small sample sizes, heterogeneous patient populations and variations in stimulation protocols. We believe that a rapid evolution of NIBS techniques from state-dependent, network-informed, multifocal and subcortical paradigms to individualized electric field modelling and accelerated NIBS protocols will improve the management of neurological disorders. However, realizing this potential will require us to address crucial challenges and acquire deeper mechanistic insights, with the aim of developing adaptive, biomarker-driven protocols to optimize target engagement, dosing and timing for each patient. Non-invasive brain stimulation (NIBS) shows considerable promise as a therapeutic strategy for neurological and psychiatric disorders. This Review explores the role of NIBS techniques, including repetitive transcranial magnetic stimulation and transcranial electrical stimulation, for treating cognitive impairments, speech and language difficulties, and motor control deficits in people with neurodegenerative or brain lesion disorders.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 12","pages":"669-686"},"PeriodicalIF":33.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-10DOI: 10.1038/s41582-025-01134-2
Joshua A. Budhu, Nicte I. Mejia, Altaf Saadi
Health disparities are preventable differences in health between different populations, and they are endemic throughout medicine owing to social, economic and environmental disadvantages. Neurology is no exception, and health disparities for systematically marginalized groups are present in the prevention, diagnosis, treatment and outcomes of all neurological disorders. The aetiology of these disparities is complex and multifactorial, reflecting the interplay of structural, institutional and individual-level factors. Elimination of these disparities is essential to improve neurological health globally. This issue is particularly timely as the global burden of neurological disorders continues to rise, with widening social inequities and limited access to care exacerbating existing gaps in outcomes. In this Review, we examine the current landscape of neurological health disparities, explore their root causes, and highlight strategies and interventions that can advance equity in neurology. This Review considers the aetiology of health disparities in neurology at an individual, interpersonal, community and societal level, and suggests practical interventions to address the multifactorial issues.
{"title":"Health disparities in neurology","authors":"Joshua A. Budhu, Nicte I. Mejia, Altaf Saadi","doi":"10.1038/s41582-025-01134-2","DOIUrl":"10.1038/s41582-025-01134-2","url":null,"abstract":"Health disparities are preventable differences in health between different populations, and they are endemic throughout medicine owing to social, economic and environmental disadvantages. Neurology is no exception, and health disparities for systematically marginalized groups are present in the prevention, diagnosis, treatment and outcomes of all neurological disorders. The aetiology of these disparities is complex and multifactorial, reflecting the interplay of structural, institutional and individual-level factors. Elimination of these disparities is essential to improve neurological health globally. This issue is particularly timely as the global burden of neurological disorders continues to rise, with widening social inequities and limited access to care exacerbating existing gaps in outcomes. In this Review, we examine the current landscape of neurological health disparities, explore their root causes, and highlight strategies and interventions that can advance equity in neurology. This Review considers the aetiology of health disparities in neurology at an individual, interpersonal, community and societal level, and suggests practical interventions to address the multifactorial issues.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 11","pages":"593-605"},"PeriodicalIF":33.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-08DOI: 10.1038/s41582-025-01143-1
Ian Fyfe
{"title":"A role for lithium in Alzheimer disease","authors":"Ian Fyfe","doi":"10.1038/s41582-025-01143-1","DOIUrl":"10.1038/s41582-025-01143-1","url":null,"abstract":"","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 10","pages":"527-527"},"PeriodicalIF":33.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-05DOI: 10.1038/s41582-025-01135-1
Heather Wood, M. Elizabeth Ross
In September 2025, the American Neurological Association (ANA) celebrates its 150th annual meeting (ANA2025), as well as the 75th anniversary of the National Institute of Neurological Disorders and Stroke (NINDS). We asked ANA President M. Elizabeth Ross about the history and achievements of the ANA and about the ANA2025 programme highlights.
{"title":"ANA2025 marks important milestones for the ANA and NINDS","authors":"Heather Wood, M. Elizabeth Ross","doi":"10.1038/s41582-025-01135-1","DOIUrl":"10.1038/s41582-025-01135-1","url":null,"abstract":"In September 2025, the American Neurological Association (ANA) celebrates its 150th annual meeting (ANA2025), as well as the 75th anniversary of the National Institute of Neurological Disorders and Stroke (NINDS). We asked ANA President M. Elizabeth Ross about the history and achievements of the ANA and about the ANA2025 programme highlights.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 10","pages":"524-525"},"PeriodicalIF":33.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-05DOI: 10.1038/s41582-025-01133-3
Marta Caballero-Ávila, Elba Pascual-Goñi, Cinta Lleixà, Lorena Martín-Aguilar, Roger Collet-Vidiella, Luis Querol
Autoimmune neuropathies, such as Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), are rare, disabling disorders. Diagnosis, follow-up and treatment of autoimmune neuropathies rely almost exclusively on clinical parameters, and the available therapies, such as intravenous immunoglobulins and corticosteroids, date from >30 years ago. The lack of therapeutic progress in autoimmune neuropathies has resulted from a combination of limited understanding of their pathophysiology, disease heterogeneity and challenges in trial design. However, advances in the past 5 years are set to change the rate of progress. The discovery of pathogenic autoantibodies that target cell-adhesion molecules at the node of Ranvier, thereby defining the new diagnostic category of autoimmune nodopathies, has provided a new perspective on disease pathophysiology. In addition, better definitions of the diagnostic criteria for GBS and CIDP, FDA approval of efgartigimod for the treatment of CIDP, promising results in trials of complement inhibitors in CIDP, GBS and multifocal motor neuropathy and the identification of biomarkers with the potential to optimize prognostication and monitoring are moving us towards targeted and precise therapeutic approaches to improve outcomes of autoimmune neuropathies. In this Review, we summarize the latest developments in autoimmune neuropathies, including discoveries in disease mechanisms, the implications of new diagnostic guidelines, identification of new biomarkers and the status of the most promising clinical trials. Management of autoimmune neuropathies has remained unchanged for much of the past 30 years, but recent advances are changing the rate of progress. In this Review, the authors summarize the latest developments, including discoveries in disease mechanisms, new diagnostic guidelines, identification of new biomarkers and the status of promising clinical trials.
{"title":"The changing landscape of primary autoimmune neuropathies","authors":"Marta Caballero-Ávila, Elba Pascual-Goñi, Cinta Lleixà, Lorena Martín-Aguilar, Roger Collet-Vidiella, Luis Querol","doi":"10.1038/s41582-025-01133-3","DOIUrl":"10.1038/s41582-025-01133-3","url":null,"abstract":"Autoimmune neuropathies, such as Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), are rare, disabling disorders. Diagnosis, follow-up and treatment of autoimmune neuropathies rely almost exclusively on clinical parameters, and the available therapies, such as intravenous immunoglobulins and corticosteroids, date from >30 years ago. The lack of therapeutic progress in autoimmune neuropathies has resulted from a combination of limited understanding of their pathophysiology, disease heterogeneity and challenges in trial design. However, advances in the past 5 years are set to change the rate of progress. The discovery of pathogenic autoantibodies that target cell-adhesion molecules at the node of Ranvier, thereby defining the new diagnostic category of autoimmune nodopathies, has provided a new perspective on disease pathophysiology. In addition, better definitions of the diagnostic criteria for GBS and CIDP, FDA approval of efgartigimod for the treatment of CIDP, promising results in trials of complement inhibitors in CIDP, GBS and multifocal motor neuropathy and the identification of biomarkers with the potential to optimize prognostication and monitoring are moving us towards targeted and precise therapeutic approaches to improve outcomes of autoimmune neuropathies. In this Review, we summarize the latest developments in autoimmune neuropathies, including discoveries in disease mechanisms, the implications of new diagnostic guidelines, identification of new biomarkers and the status of the most promising clinical trials. Management of autoimmune neuropathies has remained unchanged for much of the past 30 years, but recent advances are changing the rate of progress. In this Review, the authors summarize the latest developments, including discoveries in disease mechanisms, new diagnostic guidelines, identification of new biomarkers and the status of promising clinical trials.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 10","pages":"544-555"},"PeriodicalIF":33.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1038/s41582-025-01132-4
Ewa A. Ziółkowska, Keigo Takahashi, Patricia I. Dickson, Marco Sardiello, Mark S. Sands, Jonathan D. Cooper
The neuronal ceroid lipofuscinoses (NCLs), more commonly known as Batten disease, are a group of fatal inherited neurodegenerative lysosomal storage disorders. Each form is caused by mutations in a different gene, resulting in lysosomal dysfunction, which, by largely unknown mechanisms, has a devastating impact on the central nervous system. The NCLs are grouped together owing to their broadly shared clinical presentations and the presence of autofluorescent storage material. Nevertheless, being caused by deficiencies in dissimilar proteins, marked differences are apparent between NCLs in their clinical presentation and pathology. The effects of disease are not confined to neurons and appear unrelated to autofluorescent storage material, with glial cells also affected. The rest of the body is also affected, with life-limiting disease in the bowel and effects on other body systems, which will also require treatment for maximal therapeutic benefit. Since the development of enzyme replacement therapy for CLN2 disease, much has been learnt about the practicalities of its delivery. Considerable progress has also been made in the understanding of NCL cell biology, disease pathogenesis and potential links to other disorders. Here, we highlight these advances and how they inform the ongoing development of therapeutic strategies and their future prospects. The neuronal ceroid lipofuscinoses, or Batten disease, are a group of fatal inherited neurodegenerative lysosomal storage disorders. Despite having defined genetic causes, the underlying disease mechanisms remain poorly understood and treatments are limited. Cooper and colleagues highlight recent advances in understanding the cell biology and disease pathogenesis, which could inform future therapeutic development.
{"title":"Neuronal ceroid lipofuscinosis: underlying mechanisms and emerging therapeutic targets","authors":"Ewa A. Ziółkowska, Keigo Takahashi, Patricia I. Dickson, Marco Sardiello, Mark S. Sands, Jonathan D. Cooper","doi":"10.1038/s41582-025-01132-4","DOIUrl":"10.1038/s41582-025-01132-4","url":null,"abstract":"The neuronal ceroid lipofuscinoses (NCLs), more commonly known as Batten disease, are a group of fatal inherited neurodegenerative lysosomal storage disorders. Each form is caused by mutations in a different gene, resulting in lysosomal dysfunction, which, by largely unknown mechanisms, has a devastating impact on the central nervous system. The NCLs are grouped together owing to their broadly shared clinical presentations and the presence of autofluorescent storage material. Nevertheless, being caused by deficiencies in dissimilar proteins, marked differences are apparent between NCLs in their clinical presentation and pathology. The effects of disease are not confined to neurons and appear unrelated to autofluorescent storage material, with glial cells also affected. The rest of the body is also affected, with life-limiting disease in the bowel and effects on other body systems, which will also require treatment for maximal therapeutic benefit. Since the development of enzyme replacement therapy for CLN2 disease, much has been learnt about the practicalities of its delivery. Considerable progress has also been made in the understanding of NCL cell biology, disease pathogenesis and potential links to other disorders. Here, we highlight these advances and how they inform the ongoing development of therapeutic strategies and their future prospects. The neuronal ceroid lipofuscinoses, or Batten disease, are a group of fatal inherited neurodegenerative lysosomal storage disorders. Despite having defined genetic causes, the underlying disease mechanisms remain poorly understood and treatments are limited. Cooper and colleagues highlight recent advances in understanding the cell biology and disease pathogenesis, which could inform future therapeutic development.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 11","pages":"606-622"},"PeriodicalIF":33.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-03DOI: 10.1038/s41582-025-01131-5
Andreas Horn, Wolf-Julian Neumann
Deep brain stimulation (DBS) substantially improves motor symptoms and quality of life in people with movement disorders such as Parkinson disease and dystonia, and it is also being explored as a treatment option for other brain disorders, including treatment-resistant obsessive–compulsive disorder, Alzheimer disease and depression. Two major developments are currently driving progress in DBS research: first, the framework of adaptive DBS, which senses brain activity to infer the momentary state of the symptoms of a patient and reacts by adapting stimulation settings, and second, the concept of connectomic DBS, which identifies brain circuits that should optimally be stimulated to reduce specific symptoms. In this Perspective, we propose a unified framework that combines these two concepts. Our approach, termed adaptive circuit targeting, decodes symptom severity from brain signals and adaptively activates the most relevant symptom-response circuits. We discuss the state of the art in the adaptive and connectomic DBS fields and the research gaps that need to be addressed to unify these concepts. Deep brain stimulation (DBS) is a highly effective treatment option for movement disorders and is also being explored for other brain disorders. This Perspective proposes a unified framework, termed adaptive circuit targeting, which combines adaptive and connectomic DBS to enable decoding of symptom severity from brain signals and activation of relevant symptom-response circuits.
{"title":"From adaptive deep brain stimulation to adaptive circuit targeting","authors":"Andreas Horn, Wolf-Julian Neumann","doi":"10.1038/s41582-025-01131-5","DOIUrl":"10.1038/s41582-025-01131-5","url":null,"abstract":"Deep brain stimulation (DBS) substantially improves motor symptoms and quality of life in people with movement disorders such as Parkinson disease and dystonia, and it is also being explored as a treatment option for other brain disorders, including treatment-resistant obsessive–compulsive disorder, Alzheimer disease and depression. Two major developments are currently driving progress in DBS research: first, the framework of adaptive DBS, which senses brain activity to infer the momentary state of the symptoms of a patient and reacts by adapting stimulation settings, and second, the concept of connectomic DBS, which identifies brain circuits that should optimally be stimulated to reduce specific symptoms. In this Perspective, we propose a unified framework that combines these two concepts. Our approach, termed adaptive circuit targeting, decodes symptom severity from brain signals and adaptively activates the most relevant symptom-response circuits. We discuss the state of the art in the adaptive and connectomic DBS fields and the research gaps that need to be addressed to unify these concepts. Deep brain stimulation (DBS) is a highly effective treatment option for movement disorders and is also being explored for other brain disorders. This Perspective proposes a unified framework, termed adaptive circuit targeting, which combines adaptive and connectomic DBS to enable decoding of symptom severity from brain signals and activation of relevant symptom-response circuits.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"21 10","pages":"556-566"},"PeriodicalIF":33.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：