As patients live longer with advanced cancer, brain metastases are now becoming a frequent and even chronic condition managed with a variety of systemic agents and local treatments.¹ Radiotherapy plays a key role in treatment of intracranial lesions. Whole brain radiation therapy (WBRT) has the benefit of treating both imaging-apparent and microscopic disease. This approach can offer general intracranial disease control, but can damage healthy brain tissue, resulting in neurocognitive impairment associated with irradiation of the hippocampus.² The innovation of hippocampal-avoidance WBRT (HA-WBRT) maintains global intracranial disease control while reducing neurocognitive decline relative to traditional WBRT, even in the setting of the neuroprotectant memantine (0.74; 95% CI, 0.58−0.95; P = .02), making HA-WBRT a standard-of-care approach to appropriate patients.^3-5 Nevertheless, HA-WBRT requires several weeks of daily treatments and often time off systemic therapy. Conversely, stereotactic radiation (SRT) is given over 1 to 3 treatments to the visible lesions, allowing for higher radiation dose, better focal disease control, and sparing of healthy brain tissue, which further reduces neurocognitive toxic effects. SRT is appropriate for patients with a finite number of visible lesions but may allow microscopic disease elsewhere in the brain to progress, necessitating subsequent treatments or even salvage WBRT. In addition, the higher dose of SRT can cause radiation necrosis and inflammation, requiring steroids or other medical and surgical interventions.⁴ The optimal balance of intracranial disease control with patient-reported outcomes (PROs) is of increasing importance as patients live longer with the subacute and chronic toxic effects of radiotherapy.

To find that balance, multiple randomized clinical trials have confirmed that SRT offers improved efficacy and PROs compared with WBRT in patients with 1 to 4 brain metastases.^{2, 6-9} However, with advances in systemic therapy and surveillance, patients now frequently present with multiple brain metastases, high performance status, and expected survival of months to years. Without any high-level evidence comparing the efficacy and toxic effects of HA-WBRT with SRT in patients with 5 or more brain metastases, radiation oncologists have been left to make recommendations between each modality on a case-by-case basis. Shared decision-making attempts to account for lesion number, velocity, distribution, size, histologic findings, symptomatology, available systemic therapeutics with central nervous system penetrance, treatment goals, and tolerance for cognitive decline.

In 3,895 older adults, moderate daytime cortisol variability was associated with better cognition and slower decline, while the highest daily cortisol exposure was linked to poorer cognition and faster decline. Cortisol patterns differed between Black and White participants, but their relationships with cognition were similar, and none predicted incident Alzheimer’s disease.

Background and ObjectivesThe origin of fasciculation potentials (FPs) in the early stages of amyotrophic lateral sclerosis (ALS) remains a subject of debate. We investigated the role of the motor cortex in FP generation by comparing resting FP frequency…

Epstein-Barr Virus (EBV) is now recognized as an essential causal agent in the development of Multiple Sclerosis (MS). MS is a chronic autoimmune disease resulting in demyelination and neurodegeneration in the central nervous system (CNS). EBV is a ubiquitous human γ-herpesvirus that establishes long-term latent infection in a small subpopulation of memory B-lymphocytes. While EBV and B-lymphocytes are known to be drivers of MS autoimmune disease, it remains enigmatic how a small population of EBV-infected cells trigger and drive MS pathogenesis in some individuals. In this review, we discuss the known biology of EBV and its role in MS and other disease, including cancers, where EBV is an essential driving factor in disease progression. We review some of the conditions and cofactors that increase the risk of EBV infection leading to MS and the potential of pharmacological, biologic and vaccine approaches to more selectively target EBV to treat MS.

Keywords: EBNA1; Episome; Latency; Multiple Sclerosis; Therapeutics.

Copyright © 2026. Published by Elsevier B.V.

There is a habit of mind so embedded in Western intellectual history that we barely notice it anymore: when we want to understand the brain, we reach for the most sophisticated machine available and say, in effect, the brain is something like that. This is not merely a rhetorical convenience. It is a cognitive strategy — perhaps the only one available to us — for peering into an organ that cannot be fully observed from the inside, from the outside, or from anywhere in between. The machine metaphor is the mind’s mirror, and like all mirrors, it tells us something true and something distorted at the same time.

Researchers tested psilocybin-assisted therapy in 12 veterans with treatment-resistant PTSD. Nine patients achieved remission with no serious adverse events, supporting larger controlled trials.

Objective This study aimed to assess long-term memory outcomes in patients with temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH), compared to nonoperated TLE over a 10-year follow-up period.