{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T22:01:26Z","timestamp":1776204086901,"version":"3.50.1"},"reference-count":36,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100019721","name":"Roche Espa\u00f1a","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100019721","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis Journal \u2013 Experimental, Translational and Clinical"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Therapeutic inertia (TI) remains a critical barrier to optimizing outcomes in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We evaluated the proficiency of ChatGPT-4o in addressing complex neuro-immunological management challenges compared to practicing neurologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a comparative analysis using 21 clinical vignettes derived from a multicenter research framework. Responses from 290 neurologists were benchmarked against ChatGPT-4o, both with and without Retrieval-Augmented Generation (RAG). The primary endpoint was guideline-adherent decision-making at the item level, with the prevalence of TI as a secondary clinical outcome. Scenarios included MS therapy escalation, aquaporin-4-IgG positive NMOSD management, and serum neurofilament light chain integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ChatGPT-4o with RAG achieved significantly higher guideline adherence in decision-making than neurologists (80.5% vs. 66.5%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.001). Multivariable generalized estimating equation models identified ChatGPT-4o as an independent predictor of evidence-based decision-making (Odds ratio 3.17; 95% confidence interval: 2.05-4.88;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). While the model demonstrated a lower propensity for TI overall, performance parity occurred in emerging biomarker scenarios where clinical consensus is still evolving.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ChatGPT-4o demonstrated superior guideline adherence and reduced TI compared to neurologists. Integrating Large Language Models as clinical decision-support tools may enhance the standardization of neuro-immunological care and serve as a valuable adjunct to mitigate human cognitive biases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552173261438268","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T01:18:28Z","timestamp":1776043108000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Large language models as clinical decision-support tools in multiple sclerosis and neuromyelitis optica spectrum disorders: A comparative study of ChatGPT-4o and neurologists"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5950-9886","authenticated-orcid":false,"given":"Gustavo","family":"Saposnik","sequence":"first","affiliation":[{"name":"Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada"},{"name":"Clinical Outcomes and Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleix","family":"Solanes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Forensic Medicine, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3293-0125","authenticated-orcid":false,"given":"Enric","family":"Monreal","sequence":"additional","affiliation":[{"name":"Hospital Universitario Ram\u00f3n y Cajal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Sep\u00falveda","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel \u00c1","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Nuestra Se\u00f1ora de Candelaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan P","family":"Cuello","sequence":"additional","affiliation":[{"name":"Hospital Universitario Gregorio Mara\u00f1\u00f3n"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0342-0177","authenticated-orcid":false,"given":"Gary","family":"\u00c1lvarez-Bravo","sequence":"additional","affiliation":[{"name":"Hospital Universitari de Girona Dr Josep Trueta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8604-2054","authenticated-orcid":false,"given":"Eduardo","family":"Ag\u00fcera-Morales","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Universitario Reina Sof\u00eda, C\u00f3rdoba, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7929-1055","authenticated-orcid":false,"given":"Javier","family":"Riancho","sequence":"additional","affiliation":[{"name":"Hospital General Sierrallana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1ngel","family":"P\u00e9rez-Sempere","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9858-3555","authenticated-orcid":false,"given":"Jorge","family":"Maurino","sequence":"additional","affiliation":[{"name":"Roche Farma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9582-9230","authenticated-orcid":false,"given":"Roc\u00edo","family":"G\u00f3mez-Ballesteros","sequence":"additional","affiliation":[{"name":"Roche Farma"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,12]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-025-13293-9"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2025.106351"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-024-12305-4"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200124"},{"key":"e_1_3_4_6_2","first-page":"141","article-title":"Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - revised recommendations of the neuromyelitis Optica study group (NEMOS)","volume":"271","author":"K\u00fcmpfel T","year":"2024","unstructured":"K\u00fcmpfel T, Giglhuber K, Aktas O, et al. Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - revised recommendations of the neuromyelitis Optica study group (NEMOS). Part II: Attack Therapy and Long-Term Management. J Neurol 2024; 271: 141\u2013176.","journal-title":"Part II: Attack Therapy and Long-Term Management. J Neurol"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-025-13093-1"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1397845"},{"key":"e_1_3_4_9_2","first-page":"74","article-title":"Therapeutic inertia in the new landscape of multiple sclerosis care","volume":"9","author":"Saposnik G","year":"2018","unstructured":"Saposnik G, Montalban X. Therapeutic inertia in the new landscape of multiple sclerosis care. 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