New guidelines, approvals and practice-changing trials — each with the clinical bottom line and the source. Updated as practice moves.
The FDA accepted the new drug application for fenebrutinib, a BTK inhibitor, under priority review for both relapsing MS and primary progressive MS.
Bottom line. Not approved yet. If licensed it would be the first oral BTK inhibitor for MS and only the second drug for PPMS after ocrelizumab.
Source: NeurologyLive
Approved for adults with Parkinson's disease, with or without levodopa. TEMPO-1/2 tested it as monotherapy in early disease; in TEMPO-3 it added 1.7 h of on-time without troublesome dyskinesia versus 0.6 h with placebo.
Bottom line. A new mechanism: selective for D1/D5 receptors rather than the D2/D3 targets of pramipexole and ropinirole. Expected on the US market from October 2026.
Source: AbbVie press release
Levacetylleucine, already licensed for Niemann–Pick disease type C, received approval for ataxia-telangiectasia.
Bottom line. The first drug approved specifically for A-T, a disorder previously managed only supportively.
Source: NeurologyLive
Published in Neurology and Headache. CGRP monoclonal antibodies (eptinezumab, erenumab, fremanezumab, galcanezumab), atogepant, propranolol, topiramate, valproate and onabotulinumtoxinA are among the options with the strongest evidence. Prevention is indicated at ≥ 4 migraine days a month or significant disability.
Bottom line. CGRP-targeted drugs are first-line options — there is no need to fail older drugs first. Allow 8–12 weeks before judging a drug (24 weeks for onabotulinumtoxinA).
Source: NeurologyLive · AHS
Tenecteplase and alteplase both Class 1 within 4.5 h. IV thrombolysis at 4.5–9 h with imaging evidence of salvageable tissue (Class 2a). Thrombectomy for large-core strokes (ASPECTS 3–5) and for basilar occlusion with NIHSS ≥ 10 within 24 h (Class 1). Mobile stroke units Class 1.
Bottom line. Do not lower systolic BP below 140 mmHg after thrombolysis or thrombectomy (Class 3: harm). Medium and distal vessel occlusions remain without a recommendation for thrombectomy.
Source: TCTMD
The optic nerve becomes a fifth region for dissemination in space; central vein sign and paramagnetic rim lesions are accepted as supportive; kappa free light chains can replace oligoclonal bands; radiologically isolated syndrome can meet criteria; adapted pathways for children, older adults and people with vascular risk.
Bottom line. Earlier diagnosis is possible — but the new imaging markers need to be looked for and reported. Expect examinations to move to the 2024 criteria.
Source: NeurologyLive
FDA approval for prevention of episodic migraine at age 6–17 years and weight ≥ 45 kg. In the phase 3 trial monthly migraine days fell by 2.5 vs 1.4 with placebo.
Bottom line. CGRP monoclonal antibodies are now an option in adolescents and older children with episodic migraine.
Source: Drug Topics
Must offer: IV prochlorperazine and greater occipital nerve block. Should offer: metoclopramide, ketorolac, dexketoprofen, SC sumatriptan, supraorbital nerve block. Dexamethasone may be offered.
Bottom line. Avoid IV hydromorphone (Level A), morphine, diphenhydramine, octreotide and IV paracetamol for migraine in the ED.
Summaries are for orientation; read the source and local guidance before changing practice. Last reviewed 30 Sep 2026. Suggestions: contact@thetract.org