This Week in Neurology — Oct 28, 2026
Generated Oct 29, 2026 · 10:20
The week's practice-changing Neurology research, summarized for clinicians.
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Mechanical Thrombectomy 24 to 72 Hours after Large-Vessel Ischemic Stroke.
Thrombectomy 24 to 72 hours after anterior large-vessel stroke with salvageable tissue improved 90-day function, but raised symptomatic haemorrhage to about 5 percent and deaths to 6 percent.
New England Journal of Medicine · 2026 · PubMed
This week’s papers
- 01
Mechanical Thrombectomy 24 to 72 Hours after Large-Vessel Ischemic Stroke.
Thrombectomy 24 to 72 hours after anterior large-vessel stroke with salvageable tissue improved 90-day function, but raised symptomatic haemorrhage to about 5 percent and deaths to 6 percent.
Yang P et al. · New England Journal of Medicine · 2026
From the briefingIn the New England Journal of Medicine, Yang and colleagues report the LATE-MT trial, which randomised 336 patients in China with anterior circulation large-vessel occlusion and imaging-identified salvageable tissue, presenting between 24 and 72 hours after onset or last known well [1]. The median time to randomisation was about 38 hours, well beyond any window covered by earlier thrombectomy trials. Thrombectomy produced a better spread of disability scores at 90 days, with roughly 75 percent higher odds of a better functional outcome. That benefit came at a price: symptomatic intracranial haemorrhage occurred in about 5 percent of treated patients and in no control patients, and 90-day deaths ran at 6 percent versus about 2 percent. So this is a genuine but double-edged signal, from a single open-label trial in one country, and it supports thrombectomy in carefully imaged late presenters while leaving open questions about selection and generalisability.
If you only have time for one paper this week, make it the LATE-MT trial [1]. It reopens the question of whether a hard time window should define thrombectomy eligibility at all, while making the trade-off of more haemorrhage and more deaths impossible to ignore.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Trial of Endovascular Therapy for Mild Stroke with Large-Vessel Occlusion.
In mild large-vessel stroke with large perfusion mismatch, thrombectomy raised excellent 90-day outcomes from 50 to about 69 percent, though serious procedural complications reached 13 percent.
Liu J et al. · New England Journal of Medicine · 2026
From the briefingAlso in the New England Journal, Liu and colleagues address the opposite end of the severity spectrum in MILD-MT [2]. Among 300 patients with a National Institutes of Health Stroke Scale score below 6, a large-vessel occlusion, a small core and a large perfusion mismatch within 24 hours, an excellent outcome at 90 days was reached by about seven in ten patients after thrombectomy compared with half of patients on medical management alone. Symptomatic haemorrhage was rare and equal, with three patients in each group, but serious procedural complications affected about 13 percent of treated patients. This is a striking contrast with earlier uncertainty about mild occlusive stroke, though it applies specifically to patients with substantial perfusion mismatch and again comes from an open-label trial in China.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Dual Versus Mono Antiplatelet Therapy in Mild Versus Moderate Ischemic Stroke: A Post Hoc Analysis of the ATAMIS Randomized Trial.
In a post hoc ATAMIS analysis, clopidogrel plus aspirin reduced early neurological deterioration in moderate stroke (NIHSS 6-10) but not mild stroke, without increasing bleeding in either group.
Zhang J et al. · Stroke · 2026
From the briefingRounding out the theme in Stroke, Zhang and colleagues revisit the ATAMIS trial of clopidogrel plus aspirin versus aspirin alone [3]. In nearly 3,000 patients, dual therapy cut the odds of early neurological deterioration by roughly two thirds in moderate strokes, with scores of 6 to 10, but made no difference in milder strokes scoring 4 or 5, with no excess bleeding in either group. As a post hoc analysis, the authors themselves frame it as hypothesis-generating, but it suggests the benefit of dual antiplatelet therapy may be concentrated in more severe deficits.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Anticoagulation in Atrial Fibrillation With Previous Intracranial Bleeding: Competing Adverse Events in a Nationwide Cohort.
In Finnish patients with atrial fibrillation and prior intracranial bleeding, direct oral anticoagulants were linked to lower stroke and death without more rebleeding, whereas warfarin nearly doubled intracranial bleeding.
Tiili P et al. · Neurology · 2026
From the briefingIn Neurology, Tiili and colleagues used Finnish national registries to follow 1,502 patients with atrial fibrillation and a previous intracranial bleed [4]. Compared with no anticoagulation, direct oral anticoagulants were associated with roughly 80 percent lower risks of both ischaemic stroke and death, without a detectable rise in recurrent intracranial bleeding. Warfarin also lowered ischaemic stroke and death, but was associated with nearly double the risk of intracranial bleeding, and its benefits held mainly when time in therapeutic range was at least 70 percent. Notably, more than half of these patients received no anticoagulant at all. This is observational work with limited detail on the original bleed, so residual confounding is a real concern, but it adds weight to the view that withholding anticoagulation is not automatically the safe default.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Comparison of DOAC Versus VKA for Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis.
Pooling 14 studies of nearly 3,700 patients with cerebral venous thrombosis, direct oral anticoagulants matched vitamin K antagonists for recurrence, bleeding, functional recovery and mortality.
Khan F et al. · Stroke · 2026
From the briefingIn Stroke, a meta-analysis from Khan and colleagues pooled 14 studies, eight of them randomised, covering nearly 3,700 patients with cerebral venous thrombosis [5]. Direct oral anticoagulants and vitamin K antagonists performed similarly on recurrent thrombosis, major and minor bleeding, functional recovery and mortality, with no difference between factor Xa and thrombin inhibitors. The pooled trials remain small, but the evidence increasingly supports direct oral anticoagulants as a reasonable alternative in this young population.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Remibrutinib versus teriflunomide in relapsing multiple sclerosis (REMODEL-1 and REMODEL-2): two randomised, phase 3 trials.
In two phase 3 trials of about 2,000 relapsing multiple sclerosis patients, oral remibrutinib cut relapse rates by roughly a third versus teriflunomide, with fewer discontinuations and no liver concerns.
Wiendl H et al. · The Lancet · 2026
From the briefingIn The Lancet, Wiendl and colleagues report REMODEL-1 and REMODEL-2, twin phase 3 trials of remibrutinib, an oral, brain-penetrant inhibitor of Bruton's tyrosine kinase, against teriflunomide in about 2,000 patients with relapsing disease [6]. In both trials, remibrutinib reduced the annualised relapse rate by roughly a third. Treatment discontinuation for adverse events was about half as common as with teriflunomide, hair loss was less frequent, and the authors report no liver safety concerns. The comparator is a modest-efficacy therapy, so how remibrutinib stacks up against high-efficacy agents remains unknown, and the trials are industry-funded and ongoing.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Risk of Inflammatory Bowel Disease After Anti-CD20 Treatment in Multiple Sclerosis.
Swedish registry data linked rituximab for relapsing multiple sclerosis to markedly higher inflammatory bowel disease risk than other therapies, about one extra case per 131 treated over five years.
Kallin S et al. · JAMA Neurology · 2026
From the briefingIn JAMA Neurology, Kallin and colleagues used Swedish registries to examine inflammatory bowel disease after anti-CD20 therapy [7]. Across nearly 14,000 treatment episodes, rituximab carried an inflammatory bowel disease rate of about 110 per 100,000 person-years, compared with about 13 for natalizumab, dimethyl fumarate and fingolimod combined, and about 41 in the general population. After adjustment, the comparator therapies carried roughly 90 percent lower risk, and close to two thirds of rituximab-associated cases were Crohn disease. In absolute terms, that is one extra case for roughly every 130 patients treated over five years. The finding is observational and specific to rituximab, but it adds gastrointestinal symptoms to the monitoring picture for anti-CD20 therapy.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Short-term outcomes, longer-term disability and relapse risk in LGI1-antibody encephalitis.
In 181 LGI1-antibody encephalitis patients, early immunotherapy was associated with seizure resolution and less disability, delay worsened outcomes, and rituximab was linked to about 93 percent fewer relapses.
Ramanathan S et al. · Brain · 2026
From the briefingThat rituximab story has an interesting counterpoint in Brain, where Ramanathan and colleagues analysed 181 patients with LGI1-antibody encephalitis across international centres [8]. Immunotherapy, particularly corticosteroids, plasma exchange and rituximab, was strongly associated with seizure resolution, whereas antiseizure medications and intravenous immunoglobulin were not. Seizures frequently returned after oral prednisolone was stopped. Each month of delayed immunotherapy was associated with about a 16 percent higher risk of disability, and patients who went untreated had more disability and more relapses. Relapses occurred in close to four in ten patients, and rituximab was the only factor associated with fewer relapses, a reduction of about 93 percent. The authors also found that patient-rated quality of life drops off at a modified Rankin score of 2, arguing that only scores of 0 or 1 represent a truly good outcome. This is retrospective, real-world data, and the authors call for randomised trials, but it strengthens the case for early immunotherapy in this condition.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Internet Intervention for Functional Seizures: A Randomized Clinical Trial.
A self-guided five-session online program cut functional seizure frequency by about two thirds versus standard care through 12 months, while the therapist-guided version did not reach significance.
Higson L et al. · JAMA Neurology · 2026
From the briefingIn JAMA Neurology, Higson and colleagues ran a three-arm trial in Melbourne of an internet-delivered program for video-EEG-confirmed functional seizures [9]. Among 96 analysed adults, the five-session self-guided version cut monthly seizure frequency by roughly two thirds compared with standard care, an effect sustained at 12 months, alongside improvements in anxiety. Surprisingly, the therapist-guided version did not reach significance for seizure reduction, though the two active arms did not differ from each other directly. It is a small single-centre trial, but it offers early evidence for a scalable option where specialist psychological care is scarce.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Global best practice recommendations for genetic counselling and testing in amyotrophic lateral sclerosis.
An international consensus task force set minimum and aspirational standards for ALS genetic counselling, tiered testing and laboratory practice designed to be feasible across varied resource settings worldwide.
Salmon K et al. · Brain · 2026
From the briefingAnd in Brain, Salmon and colleagues present international consensus recommendations from the International Alliance of ALS and MND Associations on genetic counselling and testing [10], setting minimum and aspirational standards designed to work across very different resource settings as gene-targeted therapies arrive.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Neurology. This week we're covering 10 notable papers spanning the expanding boundaries of acute stroke treatment and anticoagulation, the benefits and hidden costs of immune therapies in multiple sclerosis and autoimmune encephalitis, and new approaches to functional seizures and ALS genetics. Let's dive in.
We start with acute stroke, where three trials and analyses push treatment into patient groups that have sat outside the evidence. In the New England Journal of Medicine, Yang and colleagues report the LATE-MT trial, which randomised 336 patients in China with anterior circulation large-vessel occlusion and imaging-identified salvageable tissue, presenting between 24 and 72 hours after onset or last known well [1]. The median time to randomisation was about 38 hours, well beyond any window covered by earlier thrombectomy trials. Thrombectomy produced a better spread of disability scores at 90 days, with roughly 75 percent higher odds of a better functional outcome. That benefit came at a price: symptomatic intracranial haemorrhage occurred in about 5 percent of treated patients and in no control patients, and 90-day deaths ran at 6 percent versus about 2 percent. So this is a genuine but double-edged signal, from a single open-label trial in one country, and it supports thrombectomy in carefully imaged late presenters while leaving open questions about selection and generalisability. Also in the New England Journal, Liu and colleagues address the opposite end of the severity spectrum in MILD-MT [2]. Among 300 patients with a National Institutes of Health Stroke Scale score below 6, a large-vessel occlusion, a small core and a large perfusion mismatch within 24 hours, an excellent outcome at 90 days was reached by about seven in ten patients after thrombectomy compared with half of patients on medical management alone. Symptomatic haemorrhage was rare and equal, with three patients in each group, but serious procedural complications affected about 13 percent of treated patients. This is a striking contrast with earlier uncertainty about mild occlusive stroke, though it applies specifically to patients with substantial perfusion mismatch and again comes from an open-label trial in China. Rounding out the theme in Stroke, Zhang and colleagues revisit the ATAMIS trial of clopidogrel plus aspirin versus aspirin alone [3]. In nearly 3,000 patients, dual therapy cut the odds of early neurological deterioration by roughly two thirds in moderate strokes, with scores of 6 to 10, but made no difference in milder strokes scoring 4 or 5, with no excess bleeding in either group. As a post hoc analysis, the authors themselves frame it as hypothesis-generating, but it suggests the benefit of dual antiplatelet therapy may be concentrated in more severe deficits.
Our second theme is anticoagulation in two difficult settings. In Neurology, Tiili and colleagues used Finnish national registries to follow 1,502 patients with atrial fibrillation and a previous intracranial bleed [4]. Compared with no anticoagulation, direct oral anticoagulants were associated with roughly 80 percent lower risks of both ischaemic stroke and death, without a detectable rise in recurrent intracranial bleeding. Warfarin also lowered ischaemic stroke and death, but was associated with nearly double the risk of intracranial bleeding, and its benefits held mainly when time in therapeutic range was at least 70 percent. Notably, more than half of these patients received no anticoagulant at all. This is observational work with limited detail on the original bleed, so residual confounding is a real concern, but it adds weight to the view that withholding anticoagulation is not automatically the safe default. In Stroke, a meta-analysis from Khan and colleagues pooled 14 studies, eight of them randomised, covering nearly 3,700 patients with cerebral venous thrombosis [5]. Direct oral anticoagulants and vitamin K antagonists performed similarly on recurrent thrombosis, major and minor bleeding, functional recovery and mortality, with no difference between factor Xa and thrombin inhibitors. The pooled trials remain small, but the evidence increasingly supports direct oral anticoagulants as a reasonable alternative in this young population.
Turning to multiple sclerosis, this week brings both a new oral option and a safety signal for an established one. In The Lancet, Wiendl and colleagues report REMODEL-1 and REMODEL-2, twin phase 3 trials of remibrutinib, an oral, brain-penetrant inhibitor of Bruton's tyrosine kinase, against teriflunomide in about 2,000 patients with relapsing disease [6]. In both trials, remibrutinib reduced the annualised relapse rate by roughly a third. Treatment discontinuation for adverse events was about half as common as with teriflunomide, hair loss was less frequent, and the authors report no liver safety concerns. The comparator is a modest-efficacy therapy, so how remibrutinib stacks up against high-efficacy agents remains unknown, and the trials are industry-funded and ongoing. In JAMA Neurology, Kallin and colleagues used Swedish registries to examine inflammatory bowel disease after anti-CD20 therapy [7]. Across nearly 14,000 treatment episodes, rituximab carried an inflammatory bowel disease rate of about 110 per 100,000 person-years, compared with about 13 for natalizumab, dimethyl fumarate and fingolimod combined, and about 41 in the general population. After adjustment, the comparator therapies carried roughly 90 percent lower risk, and close to two thirds of rituximab-associated cases were Crohn disease. In absolute terms, that is one extra case for roughly every 130 patients treated over five years. The finding is observational and specific to rituximab, but it adds gastrointestinal symptoms to the monitoring picture for anti-CD20 therapy.
That rituximab story has an interesting counterpoint in Brain, where Ramanathan and colleagues analysed 181 patients with LGI1-antibody encephalitis across international centres [8]. Immunotherapy, particularly corticosteroids, plasma exchange and rituximab, was strongly associated with seizure resolution, whereas antiseizure medications and intravenous immunoglobulin were not. Seizures frequently returned after oral prednisolone was stopped. Each month of delayed immunotherapy was associated with about a 16 percent higher risk of disability, and patients who went untreated had more disability and more relapses. Relapses occurred in close to four in ten patients, and rituximab was the only factor associated with fewer relapses, a reduction of about 93 percent. The authors also found that patient-rated quality of life drops off at a modified Rankin score of 2, arguing that only scores of 0 or 1 represent a truly good outcome. This is retrospective, real-world data, and the authors call for randomised trials, but it strengthens the case for early immunotherapy in this condition.
Our final theme covers access to care. In JAMA Neurology, Higson and colleagues ran a three-arm trial in Melbourne of an internet-delivered program for video-EEG-confirmed functional seizures [9]. Among 96 analysed adults, the five-session self-guided version cut monthly seizure frequency by roughly two thirds compared with standard care, an effect sustained at 12 months, alongside improvements in anxiety. Surprisingly, the therapist-guided version did not reach significance for seizure reduction, though the two active arms did not differ from each other directly. It is a small single-centre trial, but it offers early evidence for a scalable option where specialist psychological care is scarce. And in Brain, Salmon and colleagues present international consensus recommendations from the International Alliance of ALS and MND Associations on genetic counselling and testing [10], setting minimum and aspirational standards designed to work across very different resource settings as gene-targeted therapies arrive.
If you only have time for one paper this week, make it the LATE-MT trial [1]. It reopens the question of whether a hard time window should define thrombectomy eligibility at all, while making the trade-off of more haemorrhage and more deaths impossible to ignore.
Here is what this week's evidence adds up to in Neurology. First, thrombectomy now has randomised support at both extremes, very late presentation and mild deficits, but each rests on a single open-label trial from China, and both carry real procedural or haemorrhagic costs. Second, observational data suggest direct oral anticoagulants may be safer than warfarin after intracranial bleeding, and pooled data show them comparable to warfarin in cerebral venous thrombosis, though randomised confirmation in the post-bleed group is still missing. Third, remibrutinib beat teriflunomide on relapses with good tolerability, but its place against high-efficacy therapies is unsettled. Fourth, rituximab cuts both ways: an inflammatory bowel disease signal in multiple sclerosis, and an association with fewer relapses in LGI1 encephalitis, both from observational cohorts. Finally, a self-guided online program showed promise for functional seizures in a small trial awaiting replication.
That's your roundup for This Week in Neurology. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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