Should we digitalize the neurological examination?

The neurological examination (NE) has historically been central to neurological diagnosis and clinical decision-making. However, despite major advances in digital and technical medicine, the quality and relevance of the NE appear to be declining. Deficits in training begin in medical school and continue into clinical practice, resulting in reduced examination skills and increasing reliance on technical diagnostics. This trend risks marginalizing the NE, despite its continued importance as a diagnostic gatekeeper for conditions such as Parkinson’s disease, stroke, and multiple sclerosis.

The authors argue that digital technologies and novel analysis methods could strengthen rather than replace the NE. Emerging tools such as eye tracking, pupillometry, posturography, and quantitative motor analyses demonstrate the feasibility of digitally capturing neurological signs and generating sensitive biomarkers. Digitalization could improve examiner training, enhance care in underserved regions, increase diagnostic accuracy, and enable better documentation, comparability, and longitudinal assessment of findings.

Barriers to implementation include lack of validated, cost-effective tools, concerns about data protection, and insufficient reference standards. Nevertheless, these challenges are considered solvable and comparable to those faced by established technologies such as MRI or EEG. The authors call for the development of a comprehensive, user-friendly, and validated digital neurological examination, with neurologists playing a central role. Digitalizing the NE has the potential to preserve its clinical relevance and improve patient care in an era of personalized and data-driven medicine.

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