INSIGHT Launches International Effort to Advance Women’s Neurology Education

Women’s neurology is an emerging subspecialty focused on how sex- and gender-specific factors influence the risk, presentation, progression, and treatment of neurologic disease across the lifespan. Although many neurologic disorders affect both men and women, differences in hormonal milieu, immune response, vascular biology, and pharmacokinetics can meaningfully shape outcomes.¹

One organization at the forefront of advancing this space is INSIGHT (Integrating Neurological Sex and Gender Issues in Global Health Teaching), a global education-focused initiative formally launched in 2025. The network emerged from early advocacy by leaders in women’s neurology who recognized that sex- and gender-informed perspectives had historically been underintegrated into neurologic training and practice.

Two key figures in the program’s development are Esther Bui, MD, women’s neurology fellowship co-director and founder of the Women’s Neurology Program at the University of Toronto, and Mary Angela O’Neal, MD, director of women’s neurology education and director of the Functional Neurologic Disorders Division at the University of Pittsburgh Medical Center. Both clinicians are founding members of INSIGHT and continue to help expand its educational reach and global engagement.

To gain further insight, NeurologyLive^® spoke with Bui and O’Neal about the origins, mission, and future direction of INSIGHT. They described the network as a collaborative hub uniting women’s neurology programs through free webinars, international journal clubs, and modular lectures focused on pregnancy, menopause, and reproductive health. Emphasizing mentorship, shared decision-making, and preventive neurology through a sex- and gender-informed lens, they outlined how INSIGHT aims to close educational gaps and cultivate the next generation of leaders in women’s neurology worldwide.

NeurologyLive: Provide an overview regarding INSIGHT; what does it do and how does it work?

Esther Bui, MD: INSIGHT has a really important and foundational story of how it came about. The very origins came from early visionary work from leaders like Dr. Angela O'Neal, Dr. Janet Waters, and Dr. Autumn Klein, who really pushed for the prioritization of women's health in neurology. Quite shockingly, sex and gender issues—particularly differentiating between female and male factors, including pregnancy, postpartum, and now the more emerging themes of aging, perimenopause, and menopause—had not been factored in as an essential part of what we do as neurologists. Early work really began with recognizing how important it was to factor reproductive health and women's health issues into neurology.

That was many years ago, and it has been built organically through the education initiatives at Harvard's Women's Neurology Program, the University of Pittsburgh's Women's Neurology Program, and the one in Toronto, Canada. Over the last 5 to 7 years, we've partnered incredibly well, synergizing our efforts to establish a women's neurology curriculum at the American Academy of Neurology within the emerging subspecialties. That has really come to augment and build on more work, which leads us to INSIGHT.

The INSIGHT Network recognizes that this is going to be a team effort toward a unified principle of prioritizing women's health in neurology, using education as a platform and catalyst. It's been an exciting time with a brand-new program that is a collaborative network of experts and visionaries—champions in women's neurology education.

Mary Angela O’Neal, MD: When I started this work in women's health in 2010, my chair asked me to take over the women's neurology division, and it was an eye-opener. I had been a neurologist for some years and thought, “I've got this.” But it was a huge learning journey for me, collaborating with maternal-fetal medicine colleagues, women's health primary care physicians, and cardiologists. To really understand how important it is to have this sex and gender lens when you're looking at the patient in front of you makes a huge difference.

There were several programs at Mass General Brigham, UPMC, the University of Pittsburgh Medical Center, Toronto, and more recently, Dr. Riley Bove’s, MD, program at UC San Francisco. This network really started there. At the Academy of Neurology, there had always been a neurology of pregnancy course, and again, pregnancy was probably the time when people were most faced with these sex and gender issues. As Dr. Bui says, it goes well beyond pregnancy to reproductive health, menopause, and healthy brain aging.

These programs were operating independently. Then we recognized there was a clear gap across residency training, fellowship training, and among neurologists in practice. That gap was related to education. One of the reasons we wanted to set up a women’s neurology curriculum, which was approved in 2024 and is now at the AAN, was to address that.

We’ve collaborated extremely well. We have an international journal club. INSIGHT has webinars on menopause and pregnancy, and the next one will be on reproductive health. It’s a wonderful platform to exchange ideas and further education in this realm, which has really been lacking until recently.

What made the founding of the INSIGHT network necessary?

Mary Angela O’Neal, MD: I think we learn from each other, and we also learn from our colleagues in different medical specialties. For example, I’m a general neurologist with stroke training, and Dr. Bui is an epileptologist. Her knowledge of taking care of women with epilepsy is far greater than mine, and so I learn from people who are experts in their subspecialty.

In women’s health, we also learn from our colleagues in internal medicine, cardiology, and maternal-fetal medicine. It’s a knowledge base that goes across multiple disciplines. That’s why it’s great to have a platform where you can exchange ideas and learn new things. It has been a fabulous collaboration.

Esther Bui, MD: It really is a community. From the lens of an epileptologist and the interface of women’s neurology, it has been a much faster, kind of exponential growth in women’s neurology than my experience in epilepsy. I think it has to do with the fact that this is relatively uncharted territory.

It’s a rich space to grow and imagine a better space for our women patients. The community has been self-inspiring and regenerative in many ways. Dr. O’Neal has been a wonderful mentor to me, and we have built a community.

We’re beginning to see programs emerging out of established programs. I just had a meeting with Dr. Maria Dorotan, at Yale University, and they’ve established their first women’s neurology elective. Dr. Caroline Just at Cleveland Clinic has established a very robust women’s neurology program, and there is a nationwide call for a women’s neurology specialist.

Seeing that growth within what must be five to seven years of work is something I couldn’t have imagined. Building programs within seven years in epilepsy would have been unlikely.

Mary Angela O’Neal, MD: I’m now routinely asked to speak about how to build a women’s neurology program. Nobody was even thinking about that five years ago. It’s inspiring and exciting. Our residents here at UPMC are now required to do a rotation in women’s neurology, so they’ll all learn, even those who aren’t going to become fellows. It’s an exciting time.

What can clinicians learn from the INSIGHT network?

Mary Angela O’Neal, MD: I think they can learn a tremendous amount. They can learn how nuanced it is to treat a woman and how to provide the best neurological practice. It’s not just the same treatment that you would give someone of a different sex. It really needs to be honed for the woman in front of you.

Let me give you an example. I saw a woman today at Magee Hospital, which is a women’s hospital. I was asked to see her about headaches. She indicated she had migraines, which are a predominantly female issue, but she also had multiple other risk factors for stroke. She’s hypertensive, she had preeclampsia, and she smokes. These are risk factors for vascular disease and cognitive decline. She’s also in a perimenopausal time period. This is a time when we can give good advice and hopefully prevent cognitive decline or dementia, whether Alzheimer’s or vascular dementia.

There was a recent trial, the CREST-2 trial, looking at asymptomatic carotid disease and showing that aggressive medical management is critical. Now, aggressive risk factor management—including looking at women’s carotids—is super important. Advising patients and recognizing that pregnancy complications are risk factors for cognitive decline and stroke decades later is invaluable information to pass along.

We’re moving into the realm of preventive neurology. Can we actually prevent some of these complications? Knowing the questions to ask and the risk factors is super important.

Esther Bui, MD: INSIGHT is an information hub responding to the everyday realities of caring for women in the neurological space. In the early days, it was physician-led. Then it swung toward being more patient-led, with a plethora of information available on social media. Now, with AI, patients are overwhelmed and inundated with information that’s hard to disentangle.

The movement in women’s health and women’s neurology is toward a shared decision-making model. We come to the table as physicians not only with information but also with a community to iteratively gather feedback and deepen understanding. An expert like Dr. O’Neill, through INSIGHT sessions, journal clubs, or learning modules, adds value by helping us be present for the patient—not just informed by literature, but informed by experience and expert perspective. We then integrate that into this emerging model of care, which is shared decision-making.

What current issues in neurology is INSIGHT advocating for or educating people on?

Esther Bui, MD: Using education as the platform, there is incredible work being done around the world in basic science, genetics, and randomized controlled clinical trials. This space that is open and ready for innovation is education. I’ve reflected a lot on how to make the biggest impact in both incremental and long-term visionary ways.

We may not be able to change standards of practice today. Speaking as a Canadian and looking at the geopolitical landscape, sometimes policy direction isn’t up to us. What is up to us is the education piece as educators and clinical teachers.

Having that lens through education de-escalates the stakes and brings people together in a like-minded space. Let’s educate on what we already know and encourage development of the next generation of leaders in women’s neurology. That’s an important mandate for INSIGHT.

Mary Angela O’Neal, MD: I completely concur. It’s about educating and mentoring trainees. I learn something new every day, whether from colleagues or trainees. Learning, sharing, mentoring, and growing—that’s what INSIGHT is about. It’s an international journal club, which is fantastic, because it’s hard to keep up with everything happening in this space globally. There’s a lot of fantastic work.

It’s a safe space where people can share ideas. It’s growing, and people love it. The webinars are free, which removes a huge barrier. Many university-based courses require fees, but INSIGHT is barrier-free and allows us to grow and educate each other and our trainees.

What does the future look like for women’s neurology and the INSIGHT network?

Mary Angela O’Neal, MD: The future looks very bright. The idea of a women’s neurology subspecialty wasn’t even on the horizon a decade ago. I once wrote a paper about this upcoming subspecialty, and one reviewer asked, “Why do we need this?” They argued that we already have subspecialists in multiple sclerosis and epilepsy who are women’s experts.

My response was that not everything falls neatly under a subspecialty, and not every institution has those experts. I came from Mass General Brigham and am now at UPMC, where we have many subspecialists. But that’s not the case everywhere, especially in rural parts of the nation, where general neurologists are asked these questions. Understanding the nuances of sex and gender care is super important.

Esther Bui, MD: This question excites me the most. INSIGHT is about shared generational knowledge. You could have asked a hundred years ago why we needed pediatric neurology. Children and adults are different. Women and men are different. It’s important to recognize the biological lens of being female versus male. There is a lot of work to do. It’s a vast space, and we’re just at the beginning of the first mile of generational work. In epilepsy alone, only 6% of guidelines are specific to women’s health issues, even though 50% of patients are women.

Precision medicine begins not just with single genes or mutations but with the XX and XY chromosomes. If you don’t factor in that fundamental lens, you miss a huge opportunity to impact both rare and population-based diseases. It wasn’t that long ago that the NIH mandated inclusion of females in research studies. Female animals were previously excluded because they were considered too complicated. But that complexity is important to understand. Women’s neurology doesn’t only help women; it helps both sexes. If you understand the nuances, it benefits everyone. It’s a super exciting area, growing and still in its infancy.

One additional point is the important difference between sex and gender. Sex refers to biological factors—reproductive organs and hormones. Gender is also important. Being a woman in North American society may be very different from being a woman in the Middle East or Sub-Saharan Africa. The “global” in INSIGHT is important. COVID made virtual, barrier-free education possible. I hope clinicians in under-resourced countries use this as a valuable tool and join the community of physicians who believe in looking at women through a precision medicine lens.

Transcript edited for clarity. Click here to learn more about INSIGHT.

REFERENCES
1. Mauvais-Jarvis F, Merz NB, Barnes PJ, et al. Sex and gender: modifiers of health, disease, and medicine. Lancet. 2020;396(10250):565-582.