Neurology Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped neurology practice.

Alzheimer's Disease-Modifying Therapy

The amyloid hypothesis tested

No treatment → aducanumab controversy → lecanemab (CLARITY AD) → donanemab (TRAILBLAZER-ALZ 2)

Extending the treatment window

NINDS 3h (1995) → ECASS III 4.5h (2008) → perfusion-based → DAWN/DEFUSE 3 (2018)

A new class breaks through

Propranolol/amitriptyline → topiramate/valproate → CGRP mAbs (STRIVE/EVOLVE) → gepants

Flipping the treatment pyramid

Interferon/glatiramer → natalizumab (AFFIRM) → ocrelizumab (OPERA) → early high-efficacy

Three drugs, one answer

Phenytoin default → ESETT (2019, all equal) → prehospital midazolam (RAMPART)