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Background Neurologic research output is extensive, yet influential contributions remain unevenly distributed across countries and institutions. Prior studies have emphasised productivity rather than excellence, limiting understanding of where high-impact neurologic scholarship is concentrated and which structural conditions may support its development. Methods Seven annual releases (2017–2023) of the Stanford–Elsevier Lists (SEL) were analyzed between July and August 2025, and Excellent Neurologic Scholars (ENS) were extracted from the career-long and single-year SEL datasets of each release. A multilevel ecological framework was used to examine national, institutional, and individual determinants of neurologic research excellence. The main outcome measures were ENS counts, composite score (c-score), modified H-index, and citation count excluding self-citations. Results A total of 142,457 ENS records were analyzed, with 55.2% from the career-long SEL and 44.8% from the single-year SEL. High-income countries accounted for 97.8% and 95.8% of ENS, respectively, with the US alone contributing nearly half (50.1% and 47.1%). English-speaking countries collectively represented over two-thirds of ENS, while German ranked a distant second (~9%). The top 20 institutions hosted 23.1% and 24.1% of ENS, with the University of California (4.5% and 4.4%) leading, underscoring marked institutional elitism. Gender disparities were evident: women comprised 18.3% of ENS in the career-long SEL and 22.4% in the single-year SEL, with males consistently achieving higher bibliometric indicators. Academic age emerged as the only stable predictor of excellence, with each additional year increasing citation counts (ß = 135.1 and 2.4). Regression analyses confirmed independent effects of male gender, English language, income level, and HDI, while attenuating bivariate associations. Conclusion Neurologic research excellence is disproportionately concentrated in high-income, Anglophone settings and elite institutions, with persistent gender gaps. Academic age remained the strongest predictor, underscoring the need for more context-sensitive and equitable policies to support neurologic scholarship across diverse settings.
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