What Do You Consider to Be the Top Medical Advances of the Past 20 Years?

• tPA: With its approval in 1996, the use of tPA helped transform the field of neurology from one that was viewed as primarily diagnostic to one in which functional deficits could be treated and prevented. tPA decreased morbidity and mortality in ischemic stroke, and stroke centers and neuroscience intensive care units were subsequently developed.

• Neuroprotection: A prime example of neuroprotection is the use of hypothermia in neonatal hypoxic-ischemic encephalopathy. With the goal of preventing excitotoxicity and oxidative stress, evidence of decreased morbidity and mortality has been reported. Since 2005, when the first multicenter trials were published, hypothermia is now a widespread protocol and is used at numerous pediatric centers.

• Genomics and genetic testing: From the discovery of the mutation causing Rett syndrome in 1999, genomics has allowed better recognition and classification of syndromes across neurologic subspecialties, from epilepsy to neuro-oncology. The eventuating availability of clinical testing has decreased uncertainty for patients and families and allowed more tailored treatment.

• Expanding technologies of structural and functional imaging: The standard use of 1.5-T MRI, MR spectroscopy, and positron emission tomography (PET), and the increasing use of such modalities as functional MRI and diffusion tensor imaging has allowed more precise diagnosis and functional/anatomical correlation. This has had broad implications for the understanding of progression of disease and its underlying mechanisms and for the refinement of surgical treatment in epilepsy and neuro-oncology.

• Increasing understanding of autoimmune causes of neurologic disorders: The discovery of neuroactive antibodies, such as those found in neuromyelitis optica and autoimmune encephalitis, has improved our precision in prognostication and has given neurologists the opportunity to reverse symptoms in some patients who in the past would not have achieved meaningful recovery.

Top neurology advances selected by Amy Kao, MD, Attending Neurologist, Children's National Medical Center, Washington, DC.

For more on the use of genomics in neurology, read here.

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Cite this: What Do You Consider to Be the Top Medical Advances of the Past 20 Years? - Medscape - May 27, 2015.