Neurology Minute

Dr. Tesha Monteith and Dr. Patricia Pozo-Rosich discuss the latest advancements in headache medicine, focusing on key research findings from 2025. 
Show transcript:
Dr. Tesha Monteith:
Hi, this is Tesha Monteith with the Neurology Minute. Welcome to our 2026 Headache Medicine Series. I've just been speaking with Patricia Pozo-Rosich about all of the exciting advances in headache medicine in 2025. For a minute, why don't you summarize some of the key advances in headache medicine research?
Dr. Patricia Pozo-Rosich:
I think that we have good news in headache. We are currently phase two trials for two or three different compounds, anti-part two, packup and new toxins. So we are actually, I think, excited to find out the phase 2B trial results and phase three. So well, that's something that I think is worth mentioning. Then I think it is important to remember that we have new data coming from real world evidence with long-term use of anti CGRP therapies. We also have data that shows that anti CGRP therapies are useful for patients with migraine and major depressive disorder, as well as as children. Finally, I think that it is very important to remind everyone that there are new papers on practice recommendations around the world on how we have to treat our patients with migraine, and that is related both to the acute and preventive therapies. And finally, couple of position statements that have been written by the International Hague Society that strive to improve the quality of how migraine individuals are treated, and that really conveys a paradigm shift where we probably should be starting preventive therapy sooner than later.
Dr. Tesha Monteith:
Great. Thank you so much for that quick summary. And please check out the Full Headache Medicine series. I appreciate talking to you, Patricia, and look forward to discussing more highlights next time.
Dr. Patricia Pozo-Rosich:
Thank you, Tisha. See you very soon.
Dr. Tesha Monteith:
And thank you for listening to the Neurology Minutes.

In part two of the series, Dr. Andy Southerland and Dr. Seemant Chaturvedi break down key takeaways from the OCEANIC‑STROKE trial. 
Show citation: 
Read more about the OCEANIC-STROKE trial. 
Show transcript: 
Dr. Andy Southerland: 
Hello everyone. This is Andy Southerland from the University of Virginia. For today's Neurology Minute, I've just been speaking with my colleague, Seemant Chaturvedi from the University of Maryland, about exciting trials presented at this year's 2026 International Stroke Conference from the American Heart Association, American Stroke Association. And the one we want to discuss for today's Neurology Minute in brief was the OCEANIC-STROKE trial. This was a very large international trial looking at the use of a novel antithrombotic agent, a Factor XI inhibitor, compared to placebo as an adjunct to our traditional antiplatelet therapies for secondary stroke prevention. And it was received with quite a bit of excitement. So Seemant, tell us in brief, what did we learn from OCEANIC-STROKE?
Dr. Seemant Chaturvedi: 
One new class of agents, which is being tested are the Factor XIa inhibitors. And this has a unique mechanism of action, and it's believed that it can reduce thrombotic events without causing an increase in bleeding, which would be truly a major breakthrough. And so in OCEANIC-STROKE, over 12,000 patients were enrolled with either stroke or high-risk TIA within 72 hours of the last event. And the trial found that patients who had fairly mild strokes with a median NIH score of two, that when you add the asundexian 50 milligrams per day on top of either dual antiplatelet or single antiplatelet therapy, that there was an improved outcome and reduction in stroke with asundexian. There was a 2.2% absolute reduction in ischemic stroke, 26% in relative terms. Stroke, MI, and vascular death was also reduced with asundexian, as was disabling stroke. An exciting finding was that major bleeding was not increased with asundexian.
And so this confirmed the preclinical hypothesis. And so I think this was a significant result in terms of reducing recurrent ischemic stroke without increasing bleeding. And so I think we eagerly await the full publication, and I think it could be applicable to many of the patients that we see in our clinical practice.
Dr. Andy Southerland: 
So asundexian, folks, you'll hear more about this as the drug hopefully comes on the market and we see the full primary publication of this OCEANIC-STROKE trial, but exciting nonetheless to have a possible new treatment to help us reduce the risk of recurrent stroke for our patients. So Seemant, thanks so much again for joining us for today's Neurology Minute. And I encourage all of our listeners, as always, to listen to the full podcast interview ain The Neurology Podcast. Seemant, thanks for joining us.
Dr. Seemant Chaturvedi: 
My pleasure.

In part one of this series, Dr. Andy Southerland and Dr. Seemant Chaturvedi discuss two trials highlighted at the 2026 International Stroke Conference. 
Show citation: 
Read more about the CHOICE-2 trial. 
Show transcript: 
Dr. Andy Southerland:
Hello everyone. This is Andy Southerland. And for this week's Neurology Minute, I have just been speaking once again with my colleague, Seemant Chaturvedi, about his impressions from this year's 2026 American Heart Association, American Stroke Association International Stroke Conference. We've discussed a number of the very exciting pivotal trials presented at this year's meeting that occurred just a couple of weeks ago. But for the minute today, we want to just highlight two that were represented as late breaking trials in the world of acute stroke treatment. And the first was OPTION, which was a trial looking at extended window thrombolysis patients between four and a half and 24 hours. And the second was in the use of thrombolysis as an adjunct local treatment in patients receiving thrombectomy. So Seemant, to the best of your ability in our brief snippet today, what were the main highlights from these studies?
Dr. Seemant Chaturvedi:
In the OPTION trial, 570 patients were enrolled from China, and these were patients in the four and a half to 24 hour window with no evidence of large vessel occlusion. And they had a mismatch present at baseline imaging, median NIH score was seven. And when the tenecteplase was administered in this select group of patients, there was improvement in the excellent outcome of about 44% with tenecteplase and 34% with placebo. And there was a slight increase in hemorrhage of about 3%, but no increase in mortality. The second trial, CHOICE-2, also looked at thrombolysis, but it looked at local intraarterial thrombolysis following thrombectomy. And they enrolled patients with a median NIH score of 15 and the patients were enrolled from Spain and they gave a local TPA versus placebo following successful thrombectomy. And they also reported improved outcomes with about 57.5 having an excellent outcome with intraarterial TPA compared to 43% with placebo.
There was slightly increased mortality in the TPA group, but this didn't seem to be explained by intracerebral hemorrhage. And so I think both of these were very intriguing and they add some complexity to acute stroke treatment. And so primary stroke centers and comprehensive stroke centers need to discuss the results with their teams and see if they want to embrace these treatment options.
Dr. Andy Southerland:
Fantastic, Seemant. So bottom line is thrombolysis is much more than it used to be in that very narrow time window and that very narrow indication. There are now patients who may benefit in that extended time window, and it's also being shown to have benefit in cases in which we get incomplete reperfusion with our traditional mechanical thrombectomy. So take that and run with it. Hopefully we can apply it to our stroke systems of care and help patients. Thank you again, Seemant for being with us on today's Neurology Minute. Seek out the full interview and also the primary publications as well.

In part four of this series, Dr. Tesha Monteith explores the true potential of AI integration in medical education. 
Show transcript: 
Dr. Tesha Monteith:
Hi. This is Tesha Monteith with the Neurology Minute. I've been speaking with Roy Strowd, Jeff Ratliff, and Justin Abbatemarco about the use of AI in neurology education for the neurology podcast.
My take is that we're just getting started with this stuff, including the true potential of AI integration in medical education. In my regular work, I used AI to generate clinical case vignettes that help trainees practice diagnostic reasoning, and also to create patient images that better reflect the cultural diversity of our neurology population.
Beyond content creation, AI has helped me evaluate my curriculum by identifying gaps and strengths to better train fellows and residents. I've even used it as a tool to help me frame feedback, highlighting strengths, identifying areas for growth, and to provide a more forward-looking feedback approach.
AI still needs work. It should be monitored and scrutinized, and it certainly can't replace us, but it can provide meaningful augmentation of how we teach and how our learners develop.
This is Tesha Monteith. Thank you for listening to the Neurology Minute.

In part two of this series, Dr. Justin Abbatemarco, Dr. Marjo S. van der Knaap, and Romy J. van Voorst discuss the patient management card and how patients should use it. 
Show citation:
and Clinical Management of Vanishing White Matter. Neurology. 2025;105(11):e214320. doi:10.1212/WNL.0000000000214320 
Show transcript: 
Dr. Justin Abbatemarco:
Hello and welcome back. This is Justin Abbatemarco here with Romy J. van Voorst and Dr. Marjo S. van der Knaap. After discussing her article, Published Neurology Consensus Base Expert Recommendation for Diagnosis and Clinical Management of Vanishing White Matter Disease. Romy, I really want to talk with you about the patient management card. What inspired you to create that in this publication, and how should patients use that?
Romy J. van Voorst: 
So what the main motivation was of the study was actually a previous study that we did before. And in this study, we looked at the impact of any short matter on unaffected family members. And we found out that actually many family members encountered clinicians that were unfamiliar with its disease or disease-specific management. And during interviews, we saw that there was an urgent need for moral harmonization of care and also symptom management because families felt like they are left alone with just their child and no guidance on how to go further. And we wrote these recommendations to help families better understand the diagnostic and care process so they can also participate in informed decision-making. So they can understand what kind of preventive measures they can take and whether or not this interferes, for example, with quality of life goals. So there are a lot of different recommendations families can take home with.
Dr. Justin Abbatemarco: 
Marjo, anything else you want to add there?
Dr. Marjo S. van der Knaap: 
Yeah, I think the management card also helps because they have a physical card when they go to consultation or to emergency room that they can hand over. It's an official publication. It's developed by the Finishing WebMetter Expert Consortium in combination with other experts in combination with patient advocates and representatives. And so it's really a sort of a guidance that cannot be denied. So it has some authority to it.
Dr. Justin Abbatemarco: 
But I think it's a theme that applies to many neurological diseases, and addressing that. You do it really practically. And I agree, giving something more tangible for patients to present, especially to non-neurologists to help them give some guidance. It's an idea that we need to think about in clinic all the time on how we're interacting and supporting caregivers and when they're interfacing with the medical community at large. So I love what you guys have done here and to make us think about this more broadly. Thanks again for all your time and your work on this topic.
Dr. Marjo S. van der Knaap: 
Thank you for having us.