Moving artificial intelligence from research to real

Artificial intelligence (AI) applications in neurology have reached an inflection point. Despite US Food and Drug Administration approval of numerous algorithms in neuroimaging, neurophysiology, genetics and chatbots, their real-world impact remains limited. This disconnect between research promise and clinical reality represents a gap in understanding how to translate AI algorithms into clinical benefit for patients globally. In this Perspective, we examine the challenges that prevent clinical AI use in neurology moving beyond pilot studies towards meaningful clinical impact. We consider the steps required in the process of translation, including research, validation of AI models, regulatory approval pathways and clinical implementation. We discuss implementation of AI models as stand-alone products versus embedded platforms, and the requirements for sustainable deployment. Beyond traditional clinical decision support tools, we examine paraclinical applications of AI, including chatbots and ambient voice documentation. We recommend expanding capacity for prospective validation and scaling by implementing and validating technologies across multiple sites and countries, which requires infrastructure from long-term partnerships. Neurology must shift from asking whether AI can work to understanding how to use it safely at scale.

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Kings College Hospital, London, UK

James T. Teo & Mark P. Richardson

Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, UK

Neurological Institute, Cleveland Clinic London, London, UK

Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Faculty of Brain Sciences, University College London, London, UK

Epilepsy Centre at Neurological Institute, Cleveland Clinic Research, Cleveland Clinic, Cleveland, OH, USA

Department of Computational Life Sciences, Cleveland Clinic Research, Cleveland Clinic, Cleveland, OH, USA

Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark

Department of Clinical Neurophysiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

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The authors contributed equally to all aspects of the article.

Correspondence to James T. Teo.

J.T.T. has received research grant funding from the Engineering and Physical Sciences Research Council, Innovate UK, the National Institute for Health and Care Research (NIHR) and the Office of Life Sciences. He is in working groups of multiple UK public sector advisory boards (Department of Health and Social Care AI Advisory, Health Research Authority, Medicines and Healthcare Regulatory Authority and National Health Service (NHS) 10-Year Plan). He is a co-founder of and owns equity in CogStack (AI startup). He is employed by NHS public institutions as well as Cleveland Clinic London. The views in this Perspective represent his own. A.E. has received research grants from Autolus, Biogen, Innovate UK, IXICO, the Medical Research Council, Merck, the NIHR and Roche. He has served as an advisory board member for Bristol Myers Squib and Merck Serono. He is the founder of and an equity stakeholder in Queen Square Analytics. He serves on the editorial board of Neurology (American Academy of Neurology). He has received speaker honoraria from Merck, MS at the Limits and Roche for educational sessions. M.P.R. has received research grants from Angelini Pharma, Autifony Therapeutics, the Epilepsy Foundation, the Epilepsy Research Institute, the European Commission, GW Pharmaceuticals, the Medical Research Council, the NIHR and Xenon Pharma. He has served as an ad hoc adviser and has been a member of advisory boards for Lundbeck, Piramidal, UCB and UNEEG Medical. He is a co-founder of and owns equity in NeuralPulse and has licensed intellectual property to Neuronostics. He is a board member and trustee of the Epilepsy Research Institute. L.J. has received research grants from the National Institutes of Health, where she served on the Clinical Research Informatics Strategic Planning Initiative Working Group. She is the Executive Lead of the Cleveland Clinic–IBM partnership and is a board member of Microsoft’s Artificial Intelligence Industry Innovation Coalition. She serves on the National Institute of Neurological Disorders and Stroke Benchmarks for Epilepsy Research Taskforce and on the advisory committee to the Office of Science for the US Department of Energy focusing on national AI and quantum strategies to accelerate discovery. S.B. has received research grants from Danish Agency for Higher Education and Science: International Network Programme, the European Union (Eurostars Programme/EUREKA and HORIZON Europe Framework Programme), Filadelfia Research Fund, Independent Research Fund Denmark and Innovation Fund Denmark. He has received speaker honoraria from Eisai and UCB Pharma.

Nature Reviews Neurology thanks H. Fröhlich, C. Granziera, I. Nasrallah and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Teo, J.T., Eshaghi, A., Richardson, M.P. et al. Moving artificial intelligence from research to real-world clinical use in neurology. Nat Rev Neurol (2026). https://doi.org/10.1038/s41582-026-01225-8

Version of record: 29 June 2026

DOI: https://doi.org/10.1038/s41582-026-01225-8