The following summarizes some of the highlights from the 11th Congress of the European Academy of Neurology, Helsinki, Finland, June 21-24, 2025.
sNfL as a biomarker of treatment response
MS risk allele associated with retinal layer thinning
Novel uses proposed for Ozempic
Analysing broad-rimmed lesions in MS
sNfL as a biomarker of treatment response
Serum neurofilament-light chain levels may be a useful marker of response to monoclonal antibodies in MS, according to a single-centre study of 125 MS patients in Germany (Konitsioti et al. EAN 2025;EPR-054). All patients were on treatment for >2 years and were relapse-free for the preceding three months. Median age was 42 years; median duration of therapy was 3.73 years; median EDSS score was 3.0; and median disease duration was 7.0 years. The lowest sNfL levels were in patients receiving ofatumumab or natalizumab extended-interval dosing (q8weeks). sNfL levels were significantly lower in patients receiving ofatumumab, natalizumab EID, or ocrelizumab standard or extended-interval dosing compared to untreated patients. sNfL levels among the treatment groups were not significantly different. The authors noted that extended-interval dosing regimens were not associated with higher sNfL levels, and suggested that EID dosing with sNfL monitoring might be a useful strategy for de-escalating therapy.
MS risk allele associated with retinal layer thinning
The International MS Genetics Consortium recently reported that the MS risk allele rs10191329 was associated with a shorter time to EDSS worsening and greater cortical and brainstem pathology (International MS Genetics Consortium. Nature 2023;619:323-331). A new study has now found that this risk allele is associated with more rapid retinal nerve fibre layer thinning in MS patients (Bsteh et al. EAN 2025;EPR-189). Optical coherence tomography (OCT) scans were obtained from 208 MS patients; median EDSS score was 2.0. The presence of one risk allele increased the annualized rate of peripapillary retinal nerve fibre layer thinning by 0.10%/year and ganglion cell-inner plexiform layer thinning by 0.11%/year. RNFL thinning contributed 26.4% of the mean atrophy rate; GCIPL thinning contributed 27.2% of the atrophy rate.
Novel uses proposed for Ozempic
Recent studies have suggested that glucagon-like peptide (GLP)-1 agonists may have neuroprotective effects that may be beneficial for a range of neurodegenerative disorders (Kaye et al. Cureus 2024;16:e67232). A systematic review examined the evidence for Parkinson’s disease in four randomized controlled trials (N=515) (Siconolfi G. EAN 2025;EPR-248). GLP-1 receptor agonists were associated with a significantly slower progression of motor symptoms as assessed by the change from baseline in MDS-UPDRS part III scores (off medication). There were no significant effects of treatment on non-motor or motor experiences of daily living.
A separate pilot study looked at the effect of GLP-1 agonists on migraine (Braca et al. EAN 2025;OPR-012). A total of 26 obese migraine patients (BMI >30) received subcutaneous liraglutide 1.2 mg/day for 12 weeks. Mean monthly headache days decreased from 20.04 to 8.81; Migraine Disability Assessment Scores (MIDAS) decreased from 62.58 to 27.23. There was a non-significant decrease in BMI (34.01 to 33.65) during the study period. The decrease in headache frequency was not attributed to weight loss. The authors speculated that migraine frequency was reduced due to a lowering of intracranial pressure. (For a recent review of potential mechanisms see Halloum et al. J Headache Pain 2024;25:112). The study was recently published (with a larger cohort) as Braca et al. Headache 2025; epublished June 17, 2025.
Analysing broad-rimmed lesions in MS
Broad-rimmed lesions (BRLs) are lesions with a rim of HLA-positive myeloid cells and have been proposed as a marker of a more severe clinical course in MS. A European group performed a histopathological analysis of 94 mixed active/inactive lesions with a broad rim and 285 classical mixed active/inactive lesions from the Netherlands Brain Bank (Lutje et al. EAN 2025;OPR-078). BRLs had significantly larger HLA-positive rims compared to classical mixed lesions (1646 um vs. 342 um). The largest rim sizes were associated with greater MS severity at an earlier age. BRLs were also associated with a higher rate of leukocortical lesions but not subpial cortical lesions. A further observation was that rims were broader when mixed lesions were adjacent to ventricles or contained perivascular lymphocyte aggregations. The authors concluded that this finding may indicate that soluble factors in the perivascular or subarachnoid compartments may contribute to the formation of BRLs. The data have now been published as Klotz et al. Nat Med 2025;31:2016-2026.