Thought Leadership
Redefining unmet need in specialty neurology
in this article
Neurology has entered an era of unprecedented scientific progress. Advances in disease understanding, new therapeutic options and increasingly sophisticated digital technologies are reshaping what is possible across conditions from Parkinson’s disease to post-stroke care.
Yet despite this progress, many patients continue to experience delayed diagnoses, fragmented care and avoidable declines in quality of life. For healthcare systems, the challenge is becoming less about discovering what treatments are available and more about ensuring patients can access, navigate and benefit from them throughout their care journey.
As Head of Medical Affairs at Merz Therapeutics, I observe that this disconnect reveals a fundamental shift in how the pharmaceutical industry should think about unmet need.
It’s striking that with the amount of tools we have, the amount of medicine we have developed and the amount of research we have done, that we still have such a gap in unmet needs.
I would argue that this gap is increasingly defined not by the absence of innovation, but by the systems surrounding it.
I would argue that this gap is increasingly defined not by the absence of innovation, but by the systems surrounding it.
Unmet need starts
long before treatment
01
Most discussions around unmet need focus on therapies still waiting to be discovered. I believe that definition is no longer sufficient.
Instead, many of the greatest challenges emerge before treatment even begins.
People living with Parkinson’s disease, for example, frequently experience OFF episodes that remain under-recognized despite becoming increasingly well understood clinically. Women living with cervical dystonia may spend years navigating healthcare systems before reaching the right specialist. People who have experienced a stroke often receive an initial diagnosis only to lose continuity of care during rehabilitation and long-term follow-up.
The result is a recurring pattern: patients are not necessarily missing medicines… they are missing opportunities to benefit from them.
The biggest gaps in unmet need actually begin at the diagnosis stage.
As neurological diseases often progress gradually, delays in recognition can have profound consequences. Earlier diagnosis creates opportunities for earlier intervention, improved symptom management and ultimately better long-term outcomes.
The question, then, is why gaps in diagnosis persist despite unprecedented scientific progress.
The biggest gaps in unmet need actually begin at the diagnosis stage.
The challenge to address unmet need
isn’t in innovation, but in systems of care
02
Infrastructure.
Education.
Specialist access.
Follow-up.
Patient empowerment.
Clinician support.
Improving outcomes requires looking beyond individual treatments and towards the broader system that surrounds patients throughout their journey.
These are all components of a system of care. It is what determines whether innovation reaches the people living with neurological conditions in meaningful ways, and the consequences of weaknesses within that system are visible across neurology.
The idea of a “system of care” is not new. Originally developed in children’s mental health, the term describes a coordinated network of services designed to address the full spectrum of an individual’s needs; not just medical care, but also the emotional, social, educational and practical support required to achieve better long-term outcomes. Over time, the concept has evolved beyond pediatric care and is increasingly being applied across healthcare to acknowledge that most people do not experience their health conditions through isolated clinical encounters. Rather, their outcomes are shaped by how effectively clinicians, caregivers, community services, education and health systems work together throughout the patient journey.
I believe this broader definition of a system of care is particularly relevant in specialty neurology, where many conditions require lifelong management rather than episodic treatment. Improving outcomes therefore means strengthening the entire ecosystem surrounding those with neurological conditions—not simply introducing new therapies.
To illustrate, people living far from specialist centers may struggle to access expert care. Others are diagnosed but receive limited long-term follow-up. Expectations around treatment adherence are not always clearly established, and sometimes those receiving treatment may lack the confidence or knowledge to actively participate in decisions about their own care.
I view all these challenges as symptoms of the same underlying issue: healthcare systems that remain fragmented despite increasingly sophisticated medical science.
To build more sustainable systems of care, we have to work as a community—not as individuals, not in silos. Future improvements in neurological care may depend as much on strengthening healthcare pathways as developing the next therapeutic breakthrough.
Patient-centered care means designing
systems around people, not products
03
The phrase “patient-centered care” has become commonplace across healthcare, but I think genuine patient centricity requires more than listening exercises or advisory boards.
Instead, patients should influence decisions throughout the development, delivery and evaluation of care, and that includes understanding what people actually need before developing new technologies.
Let me offer the growing use of wearable devices in Parkinson’s disease as an example.
Wearables have attracted considerable attention for their ability to continuously monitor motor and non-motor symptoms outside the clinic, offering the potential for more personalized treatment decisions and richer real-world data. But technological sophistication alone does not guarantee meaningful adoption.
Emerging research suggests that patients’ experiences with wearable devices are often shaped by practical considerations as much as clinical performance. Comfort, ease of use, reliability and how seamlessly a device fits into everyday life all influence long-term adoption. Some people report feeling self-conscious wearing bulky or highly visible devices, while others find complex interfaces or frequent maintenance burdensome. Although many recognize the value of continuous monitoring, sustained engagement depends on whether the technology feels intuitive, unobtrusive and genuinely helpful in managing daily life.
This reinforces a broader principle that we advocate for at Merz Therapeutics: that innovation should begin with the people we serve rather than the technology. Understanding how people live with neurological conditions, what exactly they need, and involving them throughout product development, helps ensure that new solutions address real-world needs instead of creating elegant technologies that ultimately go unused.
After all, the start and ending point is the patient.
The same principle extends beyond product development. For people who live with neurological conditions, caregivers become advocates, coordinators, educators and companions throughout what is often a lifelong journey. Yet while their contribution is indispensable, their own needs frequently receive far less attention.
As populations age and neurological conditions become increasingly prevalent, many countries are already facing shortages of informal and professional caregivers. In Japan, for example, new community-based volunteer programs have emerged to help meet growing demand for elderly care, reflecting a broader recognition that supporting patients also means investing in the people who care for them.
Caregivers—who frequently experience emotional and practical burdens comparable to patients themselves—must become recognized as integral participants within neurological care, rather than peripheral supporters. And beyond recognition, support from the system of care matters: greater access to compassionate mental health services, education and practical resources can help equip caregivers for the realities of long-term neurological care, and strengthening the caregiving workforce itself will be essential to meeting future demand.
Patient centricity, in this view, is not a communications strategy. It is an organizational philosophy.
The phrase "patient-centered care" has become commonplace across healthcare, but I think genuine patient centricity requires more than listening exercises or advisory boards.
Patient centricity, in this view, is not a communications strategy. It is an organizational philosophy.
The future of neurology can only
be built through partnership
04
Looking ahead, I see considerable opportunity to improve our systems of care.
Yes, advances in digital technologies will improve access to knowledge, simplify complex medical information and connect healthcare professionals, patients and caregivers more effectively across geographical boundaries. At the same time, patient-reported outcomes and real-world experiences will become increasingly valuable forms of evidence alongside traditional clinical data. Together, these developments point towards a future where healthcare becomes more continuous, connected and responsive. Also, we need to continue to educate and increase awareness in the community, in particularly focusing on patients.
Nevertheless, education, evidence and technology alone will not deliver that future.
Success will depend upon healthcare professionals, patients, caregivers, researchers and industry working together to continuously improve the systems that surround care.
Because ultimately, the next chapter in neurology will not be defined solely by scientific discovery. It will be defined by whether innovation reaches every patient who stands to benefit from it.
