Thirty years of neuropalliative care: a historical documentary analysis of international and Brazilian milestones

Abstract

Background: Neurological diseases are frequently associated with high symptomatic burden, functional disability, communication difficulties, caregiver overload, and complex decision-making, making palliative care highly relevant to neurological practice. In recent decades, neuropalliative care has emerged as a structured field, although its development remains heterogeneous across countries. Objective: To analyze the historical development of palliative care in neurology in the international context and compare it with the Brazilian trajectory from 1996 to 2026. Methods: This is a historical document analysis study, based on reference publications, institutional positions, medical regulations and national and international official documents published between 1996 and 2026. Because this study exclusively used publicly available secondary data related to a specific topic in the history of medicine, submission to a Research Ethics Committee was not required. Results: Internationally, key milestones include the American Academy of Neurology's (AAN) 1996 position recognizing palliative care as a neurologist's responsibility; the 2017 Neuropalliative Care Summit, which discussed priorities and topics to be addressed; the founding of the International Neuropalliative Care Society (INPCS) in 2020; the AAN's updated position in 2022; and the INPCS Consensus in 2025, which cites priority areas for research in neurological palliative care (patient- and caregiver-centered symptoms and outcomes; neuropalliative care models; methods to support, promote, and develop neuropalliative care). In Brazil, the main milestones include: the creation of the National Academy of Palliative Care (ANCP) in 2005; the recognition of Palliative Medicine as a field of practice in 2010 and as a field of practice with the participation of Neurology in 2015; The Brazilian Academy of Neurology's (ABN) participation in the palliative medicine committee of the Brazilian Medical Association (AMB) in 2019; the creation of the ABN's Palliative Medicine Center in 2020; the creation of the Neurology Directory at ANCP in 2022; the establishment of the National Palliative Care Policy in 2024; and the consolidation of the ABN's Palliative Care in Neurology Committee in 2026. Conclusion: Over time, neuropalliative care has evolved from an ethical and clinical guideline into a structured field of neurology. In Brazil, recent advances indicate a strategic moment for its consolidation, with potential for expanding professional training, strengthening research, and integrating palliative care into neurological care pathways.