Lisa Costelloe
Consultant Neurologist at Beaumont Hospital
Professor Mohsen Javadpour and Dr Lisa Costelloe discuss how breakthrough studies in brain aneurysms and Multiple Sclerosis (MS) monitoring are helping clinicians deliver safer, smarter and more effective neurosurgical and neurological care.
Consultant neurosurgeon Professor Mohsen Javadpour speaks of his special interest in brain aneurysm research, highlighting its tangible impact on risk factor consultation and interventional treatment pathways.
Brain aneurysm research
“About 3% of the population harbour an aneurysm, most of which never rupture. So, what makes an aneurysm rupture?” he asks.
To answer this, Javadpour and his team built a prospective risk model database at Beaumont Hospital, alongside local audit nurses and nurse specialists who’ve helped to collect data on over 1,000 cases of subarachnoid haemorrhage (SAH).
“Analysing cases of ruptured aneurysm helped us to clearly identify major risk factors: hypertension increases risk 2.5-fold, smoking eightfold, but combined, the risk rises thirtyfold. This changes the way we speak to our patients about prevention.”
Further research includes leading an international multicentre study examining risk factors for aneurysm recurrence following treatment and the prospective use of aggressive, early intervention for poor-grade SAH. “Poor grade SAH has traditionally been managed in a delayed fashion, but our study of 250 patients showed that early treatment allowed over half of patients to survive and remain independent, particularly younger patients.”
“Neurosurgical research involves assessing high-risk procedures, making trial design and patient recruitment challenging,” continues Javadpour. “Despite this, neurosurgery has been at the forefront of randomised controlled trials, with our clinical research centre running and participating in multiple international studies.”
This is an extremely exciting and fruitful area of research at the moment, with a real potential to drive meaningful change for MS management
Novel outcome measure for multiple sclerosis
The last decade has transformed multiple sclerosis (MS) care, with an expansion of disease-modifying therapies providing hope to the 2.9 million people affected globally. To measure the effectiveness of potential drug candidates, novel outcome measures are urgently needed to capture subtle changes in disease activity and progression. Dr Lisa Costelloe, consultant neurologist, explains.
“Outcome measures for MS need to reflect the full diversity of the symptoms experienced,” she explains. “We often see patients with MS who feel their condition has worsened, but their MRI hasn’t changed. In addition, cognitive difficulties, fatigue, visual changes and subtle disease progression cannot always be captured with standard MRI monitoring.”
Driving effective patient management, Dr Costelloe’s team is investigating a novel potential biomarker, ocular microtremor (OMT), alongside measures of gait and cognition, as well as standard clinical monitoring. With funding from Enterprise Ireland and collaboration with local medtech company, Head Diagnostics, the research hopes to provide more comprehensive, accurate and real-time data on MS disease activity.
“We’re lucky to receive funding for this project, without which, it wouldn’t be possible,” continues Costelloe. “This is an extremely exciting and fruitful area of research at the moment, with a real potential to drive meaningful change for MS management.”
The RCSI CRC supports research within Beaumont Hospital, providing the infrastructure, support and high-level quality management needed to run complex clinical trials in-house, allowing principal investigators at Beaumont Hospital to “engage ethically and effectively in research,” explains Javadpour. “We have a strong track record of research at Beaumont, and we’re well equipped for clinical trials.”
“The clinical research centre provides the perfect infrastructure to conduct high-quality clinical research,” explains Dr Costelloe. “We have the expertise, allied services on site and a large population of neurological patients, making it an excellent platform for securing research funding.”
The expertise and infrastructure of both Beaumont Hospital and the RCSI CRC combined make it the perfect partner for international clinical research. This is evidenced by involvement in the recent neurosurgical study — the BONANZA trial — within which Beaumont Hospital is the highest recruitment site in Europe.
