On the heels of the approval of the first oral disease modifying therapy for MS (Gilenya, see p. 8), patients and neurologists have reason to be hopeful that further pharmaceutical innovations are forthcoming. The FDA is sparking optimism, too. In October, it unveiled its new Regulatory Science Initiative. As part of efforts to increase transparency and support science and innovation, the agency intends to bolster personnel and enhance leadership. FDA says it wants to speed the rate of drug approvals while ensuring safety.

For individuals affected by neurological diseases, the promise of novel interventions to treat or cure disease is a beacon of hope. But several recent studies have re-affirmed the long-held notion that medication is often just one element of effective therapy. For example, physical activity appears to improve outcomes in patients with stroke, dementia, and other neurological diseases.

Among stroke patients in a recent trial, those randomized to higherintensity treadmill walking walked farther and more quickly than controls at six weeks (Clinical Rehabilitation). And when dementia patients were randomized to six weeks of standard care or six weeks of movement training, researchers found that those in the movement group had improvements in sustained attention, visual memory and a trend in working memory (International Journal of Geriatric Psychiatry).

Physician guidance remains essential to good therapeutic outcomes and long-term quality of life. As technology continues to advance, it presents opportunities to maintain relationships with patients and encourage good outcomes. A recent review confirmed that “Telestroke” care, now incorporating Internet-based as well as telephonic interactions, is becoming increasingly more advanced (Current Neurology and Neuroscience Reports).

While intriguing from the perspective of clinical outcomes, findings such as these also point to new challenges for neurologists. As reimbursements remain stagnant or decrease from year-to-year, neurologists find themselves doing more work—ordering tests, interpreting results, coordinating care, offering consults, and providing hospital coverage among them—for less money. Finding the time to investigate and order non-traditional interventions like exercise therapy and Skyping with stroke patients may be difficult. But the early evidence suggests such interventions may be worthwhile. Furthermore, as healthcare reform takes shape, patients and clinicians may find that interventions outside the traditional margins of “medicine” may be more affordable and easier to access.