Plans to set up Irish centre for stem cell treatment of MS patients

Irish Neurological Association, Annual Meeting, Kilkenny Ormonde Hotel, 2-3 May 2024

Plans are in development to set up an Irish-based service for people with multiple sclerosis (MS) who are eligible for stem cell treatment, the Medical Independent (MI) has learned.

Stem cell therapy for MS involves autologous haemopoietic stem cell transplant (AHSCT), which resets the immune system causing the inflammation. It is indicated for patients with highly active relapsing MS despite taking disease modifying therapies. AHSCT can also slow down MS in patients with early progressive MS and active inflammation (either relapses or lesions on an MRI).

Speaking to MI at the Irish Neurological Association (INA) 2024 Annual Meeting, Prof Danny Costello, Consultant Neurologist with a subspecialty interest in epilepsy, Cork University Hospital, confirmed that there are plans to provide an Irish service for these MS patients. Currently, half of this cohort receive AHSCT in London in the UK through the HSE’s Treatment Abroad Scheme. The remainder, unable to meet the UK criteria, go to Mexico or Russia for self-funded treatment.

Approximately 10 people with MS go abroad annually for the treatment. “It is very effective [for the right patient] and is probably underutilised here,” Prof Costello commented. He said that having a local service would see uptake of AHSCT increase for suitable MS patients.

“It can be done in Ireland, but needs a significant resource to do so… the pathways are there, we just need to upscale them and [get the funding].” A decision on where to base the service in Ireland has not yet been taken; however, St James’s Hospital or Beaumont Hospital, both in Dublin, have been posited as potential locations. Work is ongoing to determine the scope of the service and the results of people who have been treated abroad to date “have been very reassuring”, he confirmed.

Prof Costello chaired the epilepsy session at the INA Annual Meeting. He noted that there have been significant positive advancements in the understanding and treatment of epilepsy in recent years.

“There has been a steady increase in the number of anti-seizure medications and we are also using novel surgical techniques including S-EEG [stereoelectroencephalography – a minimally-invasive surgical implantation of electrodes into the brain in order to better localise the seizure focus].”

One of the most exciting developments is the introduction of new medications such as stiripentol and fenfluramine for Dravet syndrome, a very challenging to treat refractory form of epilepsy.

“There is also a lot of interest in antisense oligonucleotide (ASO) therapies, particularly for epilepsy due to a mutation in a gene, like in Dravet syndrome. So there are some exciting studies coming out in relation to those as possible treatment for Dravet syndrome. There is also a new medication called cenobamate that is emerging as a very effective treatment for focal epilepsy.”

All of the epilepsy medications currently approved in Europe are available to Irish patients, as well as good surgical and support services, said Prof Costello, “which is great, but we are still left with the hard problem of about 30 per cent of epilepsy patients being drug resistant or ultra-refractory and that is a hard problem for every country.”

However, he added that the Science Foundation Ireland research centre, FutureNeuro, is focusing on the future of epilepsy treatments. It is developing a pipeline for new discoveries, “focusing on genetics, looking towards the future and precision therapies, including ASO therapies.”

“So I think we are relatively advanced in terms of epilepsy care in Ireland relative to other countries,” according to Prof Costello.