The use of stem cells for regenerative medicine has captured the public’s imagination and fuelled rising expectations of clinical benefit. Clinicians increasingly need to manage patients’ expectations of what stem cells may, or indeed may not, offer. This article examines some key problems that need to be resolved before the promise of stem cells for regenerative neurology can be realised.

Regenerative medicine is not a new discipline. It can be summarised as treatments that seek to restore structure and function after injury and, by this definition, includes solid organ transplantation. Stem cells are routinely used in haematology (blood stem cells for malignancy), plastic surgery (cultured autologous keratinocytes for skin loss or burns), and orthopaedics (autologous chondrocyte transplantation for articular cartilage defects1). But their potential in many other conditions has yet to be realised. The lack of restorative treatment for patients with progressive neurological disorders such as Parkinson’s disease, multiple sclerosis, and motor neurone disease highlights the vast unmet clinical need. Stem cells are destined to deliver new treatments for these disorders, through improving the understanding of disease pathogenesis, accelerating drug discovery and, in some instances, by direct cell based therapy. However, several challenges need to be overcome before stem cell based therapies are a clinical reality.