It is no secret that treatment options in Neurology are rapidly evolving. It is also no secret that for many chronic neurological disorders, there is no way we can even begin to think about a cure. For many conditions, the mechanisms that cause the disease are only just being identified and this is of course the start of any journey towards treatments that have curative intent. Although researchers in any field may be buoyed by the speed of progress in their own highly specialised area, it is well known that clinical implementation of any treatment takes on average about 15 years from its initial discovery. For patients, this may not be a lifetime but it certainly can feel like one. This is even more distressing if the condition is progressive, as many patients who have longstanding disease may not be suitable for a particular treatment by the time one is discovered. You can apply this to any degenerative disorder, from motor neuron disease, through to Parkinson’s Disease and Alzheimer’s Disease.
Multiple sclerosis is another such condition. In contrast to many other chronic neurological disorders, MS patients tend to be young, highly informed and heavily engaged with social media. So when a media outlet says that stem cell transplantation in Russia can cure MS, they may very well trigger a stampede. In some cases, you have to wonder if this is indeed the media’s intent and any question about the procedure’s scientific basis is deftly pushed to the side. In light of these reports about ‘stem cell’ treatment in MS, it is nice to see a reputable scientific journal such as JNNP publish a study that provides…wait for it….data!! Yes, it exists!!
In this month’s issue, the journal contains a Swedish study of autologous stem cell transplantation in MS http://jnnp.bmj.com/content/85/10/1116.abstract . A quick word for those who are from a non-medical background. What we are talking about here is not embryonic stem cells injected into a patient with MS, but rather about a procedure that has been used in the treatment of haematological malignancy for decades and which is reliant on initial high dose chemotherapy as a means of ablating the immune system.
In the Swedish study, patients had predominantly relapsing-remitting disease, although some patients with progressive disease were also studied. While retrospective in nature, the study nevertheless shows that this treatment may be effective (and safe) in certain patients with severe disabling MS. As noted by the authors, it sets the scene for future larger prospective clinical trials that may provide important insights into the risks and benefits of this treatment and which may also shed light on the patient characteristics that are most likely to predict a beneficial response.