Neurology Minute

Dr. Zohaib Siddiqi shares clinical pearls on negative myoclonus. 

Dr. Margarita Fedorova discusses the use of troriluzole for spinocerebellar ataxia.  Show citations:  https://www.neurology.org/doi/10.1212/WNL.0000000000209018  https://clinicaltrials.gov/study/NCT06034886  https://clinicaltrials.gov/study/NCT02960893 

Drs. Paul Crane, Fiifi Duodu, and Malya Sahu discuss neuroimmunology and multiple sclerosis diagnosis in Africa, including challenges and efforts to improve care.  Show citation:  Sahu M, Chomba M, Duodu F, Diaz MM, Sokhi D, Saylor D. The Current State of Diagnostics for Neuroimmunological Disorders in Africa. J Cent Nerv Syst Dis. 2025;17:11795735251385319. Published 2025 Nov 19. doi:10.1177/11795735251385319 

Dr. Elizabeth Coon and Dr. Lucy Norcliffe-Kaufmann discuss the mechanism-based therapy with ampreloxetine for neurogenic orthostatic hypotension in multiple system atrophy, highlighting recent clinical trial results and future directions.  Show citation:  Freeman R, Kaufmann H, Biaggioni I, et al. Mechanism-Based Therapy With Ampreloxetine for Neurogenic Orthostatic Hypotension in Multiple System Atrophy: A Randomized Withdrawal Trial. Neurology. 2026;107(3):e218284. doi:10.1212/WNL.0000000000218284 

Dr. Margarita Fedorova explores sex-related differences in the pharmacokinetics of levodopa among levodopa-naïve patients with PD and evaluates their relationships with levodopa-related complications. Show citation:  Conti V, De Bellis E, Corbi G, et al. Sex differences in levodopa pharmacokinetics in early Parkinson's disease: implications on levodopa-related complications. Front Pharmacol. 2026;17:1748932. Published 2026 Apr 7. doi:10.3389/fphar.2026.1748932 

In part two of this series, Dr. Halley Alexander and Dr. Heidi Munger Clary discuss the steps to take if you are screening for a psychiatric comorbidity and the results indicate that someone may be positive for depression, anxiety, or another condition.  Show citations:  Mula M, Brodie MJ, de Toffol B, et al. ILAE clinical practice recommendations for the medical treatment of depression in adults with epilepsy. Epilepsia. 2022;63(2):316-334. doi:10.1111/epi.17140  Patel AD, Baca C, Franklin G, et al. Quality improvement in neurology: Epilepsy Quality Measurement Set 2017 update. Neurology. 2018;91(18):829-836. doi:10.1212/WNL.0000000000006425  

In the August episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost highlight how the AAN's growing representation within the AMA strengthens the voice of neurology.  Stay informed by watching the President's Spotlight video.  

In part two of this series, Drs. Shuvro Roy, Jiwon Oh, and Amit Bar-Or discuss the results of the FENhance 1 and 2 trials looking at fenebrutinib in relapsing  MS.  For more information, please read about the abstract that was presented at the 2026 AAN Annual Meeting.  Read more about the Fenebrutinib Trial. 

In part one of this series, Drs. Shuvro Roy, Jiwon Oh, and Amit Bar-Or discuss the results of the fenebrutinib trial and highlight the key takeaways that healthcare providers should be aware of.   For more information, please read about the abstract that was presented at the 2026 AAN Annual Meeting.  Read more about the Fenebrutinib Trial. 

In part one of this series, Dr. Halley Alexander and Dr. Heidi Munger Clary discuss the best methods for screening patients with epilepsy in a clinical setting. Show citations:  Mula M, Brodie MJ, de Toffol B, et al. ILAE clinical practice recommendations for the medical treatment of depression in adults with epilepsy. Epilepsia. 2022;63(2):316-334. doi:10.1111/epi.17140  Patel AD, Baca C, Franklin G, et al. Quality improvement in neurology: Epilepsy Quality Measurement Set 2017 update. Neurology. 2018;91(18):829-836. doi:10.1212/WNL.0000000000006425  

In the second episode of this series, Dr. Dara Albert and Dr. Jon Stone discuss the future of FND and the innovative topics presented at the conference. 

In part two of this series, Dr. Stacey Clardy and Dr. John Ney discuss what neurologists should do differently after reading this article.  Show citation: Ney J, Fenton B, Grinberg AS, et al. Association of Military Sexual Trauma With Migraine and Migraine-Related Health Care Utilization Among Post-9/11 US Veterans. Neurol Clin Pract. 2026;16(3):e200618. doi:10.1212/CPJ.0000000000200618  

In the first episode of this series, Dr. Dara Albert and Dr. Jon Stone emphasize the main takeaway from this year's conference that should be taught to residents. 

In the first part of this series, Dr. Stacey Clardy and Dr. John Ney discuss the key clinical messages for all practicing neurologists.   Show citation: Ney J, Fenton B, Grinberg AS, et al. Association of Military Sexual Trauma With Migraine and Migraine-Related Health Care Utilization Among Post-9/11 US Veterans. Neurol Clin Pract. 2026;16(3):e200618. doi:10.1212/CPJ.0000000000200618  

In this lab minute, Dr. Stacey Clardy discusses Susac syndrome and Behçet disease. 

In this lab minute, Dr. Stacey Clardy discusses human prion disease. 

In this lab minute, Dr. Stacey Clardy discusses human prion disease. 

In the July episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost provide a mid-year review of the AAN's progress, highlighting advocacy successes and the growing momentum for brain health worldwide.  Stay informed by watching the President's Spotlight video.  

Dr. Derek Stitt and Dr. Jennifer Morganroth discuss why identifying carrier status is so important.  Show citation:  Morganroth J, Yasek J, Harms M. Preparing Amyotrophic Lateral Sclerosis Clinics to Provide Longitudinal Care for Individuals Carrying ALS Risk Variants. Neurol Genet. 2026;12(4):e200406. Published 2026 Jun 24. doi:10.1212/NXG.0000000000200406  

Dr. Justin Abbatemarco and Sukhun Kang discuss seeding trials and other hidden marketing tactics in clinical trials, and their implications for clinical practice and patient care.  Show citation:  Kang S, Lin I, Ekblom M, and Chang S. Clinical trials that are actually marketing ploys targeting doctors – how seeding trials put profit over patients. The Conversation. 2026;6(5). doi:10.64628/AAI.cxdfhnh9s

Dr. Margarita Fedorova discusses the DRAIN trial and the efficacy of acetazolamide in idiopathic normal pressure hydrocephalus.  Show citation:  Virhammar J, Fasth O, Ekblom M, et al. Safety, tolerability, and efficacy of acetazolamide in idiopathic normal pressure hydrocephalus (DRAIN) in Sweden: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol. 2026;25(6):550-559. doi:10.1016/S1474-4422(26)00126-2 

Dr. Matthew Robbins discusses the assessment and diagnosis of headache in emergency settings, emphasizing red and green flags to differentiate primary from secondary headaches. This episode provides practical tips for trainees and clinicians to improve headache management. Show citation:  Robbins MS. Diagnosis and Management of Headache: A Review. JAMA. 2021;325(18):1874-1885. doi:10.1001/jama.2021.1640  

In the second episode of this series, Dr. Dara Albert and Dr. Scott Perry discuss common barriers to transitioning from pediatric to adult care and share practical strategies clinicians can use to support successful patient transitions. Show citation:  Perry MS, Nascimento FA, Pina-Garza JE, et al. Addressing Barriers to Transitioning Pediatric Patients With Epilepsy to Adult Health Care in the United States: A Narrative Review. Neurol Clin Pract. 2026;16(3):e200616. doi:10.1212/CPJ.0000000000200616 

To celebrate 75 years of Neurology®, Dr. Chris Boes and Dr. José Merino discuss the journal's history, its evolution, and what lies ahead for the future of Neurology®.   Read more about the first 75 years of Neurology®.   

In part one of this series, Dr. Dara Albert and Dr. Scott Perry discuss what every neurology resident should know about caring for young adults with epilepsy as they transition from pediatric to adult neurology. Show citation:  Perry MS, Nascimento FA, Pina-Garza JE, et al. Addressing Barriers to Transitioning Pediatric Patients With Epilepsy to Adult Health Care in the United States: A Narrative Review. Neurol Clin Pract. 2026;16(3):e200616. doi:10.1212/CPJ.0000000000200616 

In this episode, Dr. Jonathan Crowe reviews the Capitol Hill Report from June 22nd, discussing milestones related to the Improving Seniors' Timely Access to Care Act.  Stay updated with what's happening on the hill by visiting aan.com/chr.  Learn how you can get involved with AAN advocacy. 

In the third part of this series, Dr. Halley Alexander explores emerging trends and recent advances in epilepsy.  Show citation:  Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466  Hingray C, Popkirov S, Kozlowska K, et al. Functional/dissociative seizures: Proposal for a new diagnostic label and definition by the ILAE task force. Epilepsia. 2025;66(11):4162-4182. doi:10.1111/epi.18574 Krauss GL, Elizebath R, Wheless SSJW, et al. Phase III Trial of EpiWatch for Tonic-Clonic Seizure Detection in Children and Adults. Neurology. 2026;2 (2) e000111. doi:10.1212/WN9.0000000000000111 

In the third part of this series, Dr. Halley Alexander explores emerging trends and recent advances in epilepsy.  Show citation:  Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466  Hingray C, Popkirov S, Kozlowska K, et al. Functional/dissociative seizures: Proposal for a new diagnostic label and definition by the ILAE task force. Epilepsia. 2025;66(11):4162-4182. doi:10.1111/epi.18574 Krauss GL, Elizebath R, Wheless SSJW, et al. Phase III Trial of EpiWatch for Tonic-Clonic Seizure Detection in Children and Adults. Neurology. 2026;2 (2) e000111. doi:10.1212/WN9.0000000000000111 

In part two of this series, Dr. Halley Alexander discusses seizure types, epilepsy types, and the etiology of epilepsy.  Show citations:  Beniczky S, Trinka E, Wirrell E, et al. Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy. Epilepsia. 2025;66(6):1804-1823. doi:10.1111/epi.18338  Beniczky S, Trinka E, Wirrell E, et al. A practical guide to the updated seizure classification 2025. Epileptic Disord. 2025;27(6):1087-1104. doi:10.1002/epd2.70110 

Dr. Greg Cooper and Dr. Elisabeth Kurpershoek discuss how clinicians communicate uncertainty during Parkinson's disease diagnosis and how this impacts patient trust and understanding.  Show citation:  Hillen MA, Kurpershoek E, Huisman MHB, et al. Clinician Communication About Uncertainty During Parkinson Disease Diagnostic Consultations. Neurol Clin Pract. 2026;16(3):e200613. doi:10.1212/CPJ.0000000000200613 

Dr. Katie Krulisky and Dr. Marcus Pinto discuss the diagnosis and management of hereditary ATTR amyloidosis. Show citation:  Panrudkevich AH, Jones FJS, Shouman K, et al. Sensitivity of Nerve and Skin Biopsy and Fat Aspirate for Amyloid in Symptomatic Hereditary ATTR Amyloidosis With Peripheral Neuropathy. Neurology. 2026;106(11):e218033. doi:10.1212/WNL.0000000000218033 

In part one of this series, Dr. Halley Alexander explores epilepsy diagnosis.  Previously posted Neurology Minute episodes related to epilepsy syndromes and their diagnosis.  Show citation:  Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-482. doi:10.1111/epi.12550  

Dr. Aaron Zelikovich discusses the frequency of LRP4-IgG in patients with suspected MG using different cell-based assay protocols.  Show citation:  Vacchiano V, Milano DC, Ricciardiello F, et al. Low Prevalence and Inconsistency of LRP4-IgG Detection in Suspected Myasthenia Gravis: A Multicenter CBA Comparison Neurology: Neuroimmunology & Neuroinflammation. 2026;13(3). doi:10.1212/NXI.0000000000200554 

In part two of this series, Dr. Andy Southerland and Dr. Seemant Chaturvedi discuss the use of dual antiplatelet therapy with intravenous thrombolysis in patients with acute ischaemic stroke.  Read more about the TAPIS trial.  

In part one of this series, Dr. Andy Southerland and Dr. Seemant Chaturvedi discuss insights from the LATE-MT trial that was presented at the 2026 European Stroke Organization Conference.  Read more about LATE-MT trial.  

Dr. Shuvro Roy and Dr. Michael Levy discuss satralizumab for treating relapsing MOGAD, current management challenges, and the encouraging results of this new therapy.  Read more about this abstract.    

In part three of this series, Dr. Aaron Zelikovich discusses the clinical outcomes seen during and after the acute infection and how these findings can guide physicians in counseling their patients.  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 

In part two of this series, Dr. Jeff Ratliff and Dr. Gabriela Figueiredo Pucci discuss the lessons and experiences that happen in neurology-related social media interaction.  Show citation:  Pucci GF, Gheihman G, Albin CSW. Education Research: A Qualitative Analysis of the Role of Social Media in Neurology Trainees' Professional Identity Formation. Neurol Educ. 2026;5(2):e200307. Published 2026 Apr 22. doi:10.1212/NE9.0000000000200307  

In part two of this series, Dr. Stacey Clardy and Dr. John Ney discuss the primary limitation of using claims data to estimate wait times for neurology services, particularly in rural areas or for subspecialty neurology care.  Show citation: Laffargue EK, Van Der Goes DN, Wilson AM, Parziale SD, Sico JJ, Ney J. Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States: 2019-2023. Neurology. 2026;106(10):e218008. doi:10.1212/WNL.0000000000218008  

In part two of this series, Dr. Stacey Clardy and Dr. John Ney discuss the primary limitation of using claims data to estimate wait times for neurology services, particularly in rural areas or for subspecialty neurology care.  Show citation: Laffargue EK, Van Der Goes DN, Wilson AM, Parziale SD, Sico JJ, Ney J. Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States: 2019-2023. Neurology. 2026;106(10):e218008. doi:10.1212/WNL.0000000000218008  

In part one of this two-part series, Dr. Jeff Ratliff and Dr. Gabriela Figueiredo Pucci shares the most important takeaway about professional identity formation among those actively engaged in neurology communities on social media.  Show citation:  Pucci GF, Gheihman G, Albin CSW. Education Research: A Qualitative Analysis of the Role of Social Media in Neurology Trainees' Professional Identity Formation. Neurol Educ. 2026;5(2):e200307. Published 2026 Apr 22. doi:10.1212/NE9.0000000000200307  

In part one of this series, Dr. Stacey Clardy and Dr. John Ney break down the difference between mean and median wait times for new neurology appointments.  Show citation: Laffargue EK, Van Der Goes DN, Wilson AM, Parziale SD, Sico JJ, Ney J. Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States: 2019-2023. Neurology. 2026;106(10):e218008. doi:10.1212/WNL.0000000000218008  

Dr. Gillian L. Gordon Perue discusses asundexian and the OCEANIC-STROKE trial. Show citation:  Sharma M, Dong Q, Hirano T, et al. Asundexian for Secondary Stroke Prevention. N Engl J Med. 2026;394(15):1467-1479. doi:10.1056/NEJMoa2513880 

Dr. Madeline Russell discusses a common complication faced by patients with acute ischemic stroke.  Show citation:  Schwarz G, Cascio Rizzo A, Ambler G, et al. Contrast-Associated Acute Kidney Injury After Thrombectomy for Ischemic Stroke: Prognostic Impact and CAN-REST Predictive Score. Neurology. 2026;106(6):e214655. doi:10.1212/WNL.0000000000214655  

Dr. Bradley Ong discusses the use of eptinezumab in combination with patient education is an effective treatment for reducing disease burden in patients living with chronic migraine complicated by medication overuse.  Show citation:  Jensen RH, Lundqvist C, Schytz HW, et al. Eptinezumab With Patient Education for Chronic Migraine and Medication-Overuse Headache: The Randomized, Placebo-Controlled RESOLUTION Trial. Neurology. 2026;106(8):e214863. doi:10.1212/WNL.0000000000214863 

Dr. Dan Ackerman and Dr. Reza Bavarsad Shahripour discuss the diagnostic performance of 4 major modalities: TCD, TTE, TEE, and cardiac CT in patients with embolic stroke of undetermined source.  Sho citation:  Read the related article in Neurology® Clinical Practice.     

Dr. Shuvro Roy and Dr. Amanda Piquet discuss a brief overview of stiff person syndrome, as well as the trial and the trial results.  Read more about this abstract on the AAN website.   Show transcript:  Dr. Shuvro Roy: Hi, this is Shuvro Roy from the University of Washington and welcome to today's Neurology Minute. I just wrapped a longer conversation with Amanda Piquet from the University of Colorado Anschutz School of Medicine. We were just talking about the recent Phase 2 trial evaluating Miv-cel Kyverna Therapeutics' anti-CD19 CAR T-cell therapy in patients with Stiff Person Syndrome. Amanda, would you mind taking us through a brief overview of SPS as well as the trial and their trial results? Dr. Amanda Piquet: So Stiff Person Syndrome, or SPS, is a rare disabling autoimmune neurologic disease with a major unmet need. About 80% of patients ultimately lose their mobility and we currently have no FDA approved therapies. Existing treatments like IVIG, rituximab, and plasmapheresis are all used off label, often requiring chronic dosing and frequently failing to stop progression. KYSA-8 is a registrational Phase 2 study of 26 patients with refractory SPS. Patients experienced rapid, statistically significant and clinically meaningful improvement across all primary and secondary endpoints. Primary endpoint was the timed 25-foot walk. And this improved by a median of 46% at 16 weeks. Of patients requiring walking aids at baseline, about two thirds no longer needed them by week 16 to complete that 25-foot walk. Some patients who had struggled to walk were even able to run again after treatment. Another key finding was that all patients discontinued chronic immune therapies and remained off treatment as of the last follow-up. From a safety standpoint, miv-cel was generally well tolerated, with no high grade CRS or ICANS observed. In my opinion, these outcomes are unlike anything we've seen previously with Stiff Person Syndrome and may represent a paradigm shift, not only for SPS, but potentially for other antibody-mediated neurologic diseases more broadly. Dr. Shuvro Roy: Just curious, are there any upcoming implications for the application of this treatment for patients, you think, in the coming year or so? Dr. Amanda Piquet: Kyverna, the company who developed miv-cel, has initiated a rolling BLA with the FDA for potential approval and this would be, if approved, the first CAR-T therapy for SPS. So we're anxiously awaiting the outcome of that process. Dr. Shuvro Roy: Fantastic. Amanda, thank you so much for your time. And if you are intrigued and want to know more details behind the findings in the study as well as a conversation around CAR-T therapy for autoimmune neurologic disease as a whole, I encourage you to check out the Neurology Podcast feed for our full conversation there. Thanks for tuning in.  

Dr. Shuvro Roy and Dr. Amanda Piquet discuss a brief overview of stiff person syndrome, as well as the trial and the trial results.  Read more about this abstract on the AAN website.   Show transcript:  Dr. Shuvro Roy: Hi, this is Shuvro Roy from the University of Washington and welcome to today's Neurology Minute. I just wrapped a longer conversation with Amanda Piquet from the University of Colorado Anschutz School of Medicine. We were just talking about the recent Phase 2 trial evaluating Miv-cel Kyverna Therapeutics' anti-CD19 CAR T-cell therapy in patients with Stiff Person Syndrome. Amanda, would you mind taking us through a brief overview of SPS as well as the trial and their trial results? Dr. Amanda Piquet: So Stiff Person Syndrome, or SPS, is a rare disabling autoimmune neurologic disease with a major unmet need. About 80% of patients ultimately lose their mobility and we currently have no FDA approved therapies. Existing treatments like IVIG, rituximab, and plasmapheresis are all used off label, often requiring chronic dosing and frequently failing to stop progression. KYSA-8 is a registrational Phase 2 study of 26 patients with refractory SPS. Patients experienced rapid, statistically significant and clinically meaningful improvement across all primary and secondary endpoints. Primary endpoint was the timed 25-foot walk. And this improved by a median of 46% at 16 weeks. Of patients requiring walking aids at baseline, about two thirds no longer needed them by week 16 to complete that 25-foot walk. Some patients who had struggled to walk were even able to run again after treatment. Another key finding was that all patients discontinued chronic immune therapies and remained off treatment as of the last follow-up. From a safety standpoint, miv-cel was generally well tolerated, with no high grade CRS or ICANS observed. In my opinion, these outcomes are unlike anything we've seen previously with Stiff Person Syndrome and may represent a paradigm shift, not only for SPS, but potentially for other antibody-mediated neurologic diseases more broadly. Dr. Shuvro Roy: Just curious, are there any upcoming implications for the application of this treatment for patients, you think, in the coming year or so? Dr. Amanda Piquet: Kyverna, the company who developed miv-cel, has initiated a rolling BLA with the FDA for potential approval and this would be, if approved, the first CAR-T therapy for SPS. So we're anxiously awaiting the outcome of that process. Dr. Shuvro Roy: Fantastic. Amanda, thank you so much for your time. And if you are intrigued and want to know more details behind the findings in the study as well as a conversation around CAR-T therapy for autoimmune neurologic disease as a whole, I encourage you to check out the Neurology Podcast feed for our full conversation there. Thanks for tuning in.  

In the fourth episode of this series, Dr. Stacey Clardy discusses care team essentials and working within multidisciplinary teams.  Show transcript:  Dr. Stacey Clardy: This is the Neurology Minute. I'm Stacey Clardy from the Salt Lake City VA and the University of Utah. This is our 4th episode in our four-part series on Rett syndrome. Today we're going to discuss care team essentials and working within multidisciplinary teams. Rett syndrome requires coordinated, ongoing, multidisciplinary care across the lifespan. So core team members will often include neurology, genetics, developmental pediatrics, gastroenterology, pulmonology, cardiology, orthopedics, and a range of rehabilitation specialists. Speech language pathology especially plays a central role, particularly through augmentive and alternative communication strategies, given the characteristic profound expressive language limitations in Rett syndrome. Care coordination obviously is essential, and neurologists will usually serve as the central point of integration, helping families navigate the complexities of care systems internationally and anticipating who might need to be brought in at certain times, given evolving needs. And caregiver input is especially critical in Rett syndrome patients because the patients have limited verbal communication. So it's these caregivers who are going to be able to provide key insights into daily neurologic status, behavior, and subtle clinical changes that clinicians may well not be able to detect in periodic short office visits. Another essential component is transition planning, right?  As Rett syndrome patients age, structured transition from pediatric to adult care systems is necessary, essential to maintain continuity and avoid fragmentation. And as in any rare disease, many families find that participation in specialty clinics, and registries, and clinical trials, when available, can provide access to evolving therapies and contribute to ongoing advances in the field. That's it for our Rett syndrome series. Be sure to listen to the three prior Neurology Minute episodes on Rett syndrome for a full overview. I'm Stacey Clardy for the Minute. 

Dr. Stacey Clardy discusses methylenetetrahydrofolate reductase (MTHFR) in this lab minute.   Show transcript:  Dr. Stacey Clardy: Hi, this is Stacey Clardy from the Salt Lake City VA in the University of Utah. Let's do a lab minute today on MTHFR. This one just simply will not go away. This is one of those topics where a huge amount of patient anxiety is inversely proportional to the utility of a test. So MTHFR is methylenetetrahydrofolate reductase. It's the enzyme that helps generate five methyltetrahydrofolates supporting remethylation of homocysteine to methionine. That biochemistry does matter because the clinical leap that often follows is the problem. So the common polymorphisms of MTHFR are C677T and A1298C. They are widespread in the general population. A recurring misunderstanding is that ordering MTHFR genotyping in a thrombophilia evaluation or as a catchall explanation for you name it, migraines, neuropathy, psychiatric symptoms, nondescript inflammation, is going to give you the answer. The best evidence-based guidance is that MTHFR polymorphism testing has minimal clinical utility and should not be ordered routinely, particularly not as part of a thrombophilia evaluation.So what do we do when a patient arrives with one of these MTHFR results and they are concerned? I try to translate into what actually matters clinically. If there is a concern for thrombotic risk or a documented thrombotic risk event, I focus on established thrombophilias and clinical risk factors and not common MTHFR isolated variants. Now, if the concern is folate metabolism and homocystine, well, we can actually measure those nutritional markers and homocystine. And so if homocystine is elevated, the next thing I'll do is consider the context. And if their folate is low or if one of their B vitamins is low, I replace it rather than building a medical mythology around a genotype that's not going to change the management for most patients. So that's an approach and an update to MTHFR. I hope it's helpful. This is Stacey Clardy, until next time. 

In the June episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost discuss the sense of community present within the AAN.  Stay informed by watching the President's Spotlight video.   Show transcript:  Dr. Jason Crowell: This is Jason Crowell with today's Neurology Minute. Once again, this month for our presidential spotlight, we have Natalia Rost joining us. Natalia, thanks so much for your time today. Dr. Natalia Rost: Hi, Jason. Dr. Jason Crowell: So what is on your mind this month, Natalia? Dr. Natalia Rost: Well, if you remember, last month we talked about our annual meeting, and since I've been thinking about AAN's value of community. Community is top of mind because staying connected, of course, sharing questions, experience, and ideas is how we keep improving care and advancing the field, but also how we elevate wellness for all of us. Dr. Jason Crowell: I'm sure there are many different ways we could talk about this sense of community showing up within the AAN, but what are you thinking of specifically? Dr. Natalia Rost: Well, of course, we love our annual meeting reunions, but one way we thrive as a community all year long is online through our AAN member sections. As you know, sections are our AAN vibrant member-led groups and each has a dedicated community on Synapse, our online community platform and mobile app. What you'll find there is discussions, resources, announcements, events, and peer Q&A. Dr. Jason Crowell: So can you give us some examples of how these sections work and how people participate? Dr. Natalia Rost: Yeah. Sections is our online community and our response onto how our field moves fast and sections are where you can stay connected and share knowledge. Every section is dedicated to a different subspecialty or interest. No matter where your focus is, there's probably an AAN online community. For instance, with my specialty in vascular neurology, I can connect with other members in the stroke and vascular neurology section. The topics can range from a tricky case question sharing a protocol or a career advice thread and we've done that for years now. But I'm also passionate about humanities and art, and so I can also explore the interface between neurology and the arts in my neuro-humanities synapse community. I highly recommend it.  Dr. Jason Crowell: Are there any practical real-life benefits that members talk about when they're discussing these sections, and who all is behind the scenes making this work happen? Dr. Natalia Rost: Yeah. In addition to staying in touch all year long, many of our sections also host collaborative sessions during the annual meeting through section showcases. These are discussion-based sessions where sections present untimely topics. And if you're interested, I recommend joining a section now so you can stay on top of the advances for 2027. And for additional context, we also have 80-plus section leaders. These members offer their time and expertise to help their communities thrive, and so we're extremely grateful to them for their leadership. Dr. Jason Crowell: So if we have listeners today who are members of the AAN, but they've never gotten involved in these sections, where would you direct them? I imagine they can find information on the AAN website. Dr. Natalia Rost: Yes. So very simple. Any AAN member can join sections and access their communities on Synapse. Go to aan.com/sections and access them anywhere by downloading our Synapse mobile app. And my advice is very simple. Find your people, stay current, and bring your questions. Your section community is there year-round. Dr. Jason Crowell: Terrific. Natalia, thanks so much for sharing this with us. Dr. Natalia Rost: Thanks for having me.