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A small randomized trial of 36 people with mild to moderate multiple sclerosis linked N-acetylcysteine treatment to changes in brain connectivity and glucose metabolism over about four months. Participants receiving NAC also reported improvements in several symptoms, but the study does not establish that the antioxidant is an effective MS treatment.
A 36-person randomized trial found that people with mild to moderate multiple sclerosis who received N-acetylcysteine (NAC) had changes in brain connectivity and glucose metabolism on imaging, alongside self-reported improvements in several symptoms. The findings, reported by MedPage Today from a scientific meeting and published in IBRO Neuroscience Reports, are preliminary and do not show that NAC slows MS or should replace established treatment.
The trial assigned 18 participants to NAC plus standard care and 18 to standard care alone. The NAC group received an intravenous dose of 50 milligrams per kilogram once a week, plus 500 milligrams by mouth twice daily on the other six days of each week. Researchers assessed participants at the start and again after four months, with a possible two-month variation in follow-up timing.
Using an integrated PET-MRI platform, investigators measured resting-state brain activity with blood oxygen level-dependent functional MRI and glucose metabolism with fluorodeoxyglucose PET. Compared with the control group, the NAC group showed significant connectivity changes in the inferior frontal region, cerebellum, and parts of the temporal and parietal lobes. PET scans also showed increased glucose metabolism in several of those areas, including the inferior frontal and inferior temporal gyri.
Participants receiving NAC reported improved scores for pain, fatigue, cognition and attention after treatment; the researchers reported statistical P values of 0.015, 0.016, 0.036 and 0.010, respectively. The account says clinical improvements emerged in the NAC group only. Self-reported cognition and attention improvements correlated with imaging changes, but that association does not establish that the brain changes caused the reported improvements.
A Possible Addition to MS Research
The findings point to a possible way to study oxidative stress alongside brain function in MS. NAC can increase glutathione, an antioxidant in the brain, and the investigators framed it as a potential complement to treatments that address inflammation. The imaging results offer researchers measurable signals to investigate in future trials, while the symptom questionnaire results suggest areas for further testing.
The study does not establish a treatment benefit for patients. It was small, followed participants for roughly four months and used a treatment schedule combining intravenous and oral NAC. The reported symptom outcomes were self-reported, and imaging changes are not by themselves proof of meaningful or lasting clinical improvement. Patients should not start, stop or alter MS treatment based on these early findings; treatment decisions belong with a qualified health professional.
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How Researchers Tested NAC
MS is a disease of the central nervous system, and cognitive difficulties can affect some people living with it. In comments reported by MedPage Today, study presenter Sahar Darabi Monadi said that inflammation and oxidative stress may both contribute to cognitive impairment. She argued that NAC could address an area not directly targeted by many approved MS therapies; that is the researchers’ rationale, not a conclusion established by this trial.
The study measured imaging and clinical questionnaire results at two time points, comparing participants assigned to NAC plus standard care with those receiving standard care. Co-author Andrew Newberg said earlier work had examined NAC in other neurological conditions and noted concerns that oral absorption can vary. The trial therefore used both intravenous and oral doses. The report describes this study as an initial evaluation in people with MS, rather than a definitive test of long-term benefit.
“The imaging findings seemed to correspond to some of the clinical improvements people were reporting.”
— Andrew Newberg, MD, of Thomas Jefferson University, as quoted by MedPage Today
Questions About Benefit and Dose
The report does not establish whether NAC produces lasting improvements, affects MS disease progression, or benefits people with different levels or types of the disease. The trial included only 36 people, and the available account does not provide enough detail to judge how well its results apply to the wider MS population. It also does not establish which part of the combined intravenous and oral regimen, if either, was associated with the findings.
Further studies would need to clarify appropriate dose, treatment duration and timing, as well as whether imaging changes translate into clinically meaningful benefits. The reported relationship between symptom scores and imaging cannot establish cause and effect. The available report also does not describe enough information to assess the durability of outcomes beyond the follow-up period.
Further Trials Must Test NAC
Newberg said the researchers hope the initial results lead to more detailed studies that clarify NAC dosing, duration and timing. Larger and longer trials would be needed to test whether the symptom changes are reproducible, whether they persist, and whether NAC adds benefit to standard MS care. Until such evidence is available, the findings remain a research signal rather than a basis for clinical recommendations.
Key Questions
What did the multiple sclerosis study find?
The 36-person trial linked NAC treatment to changes in brain connectivity and glucose metabolism on imaging. Participants in the NAC group also reported improvements in pain, fatigue, cognition and attention after treatment.
Does this study prove NAC treats multiple sclerosis?
No. The study was small and preliminary. It does not establish that NAC slows MS, causes lasting symptom improvement or should replace standard care.
How was NAC given in the trial?
The treatment group received 50 milligrams per kilogram intravenously once a week and 500 milligrams orally twice daily on the other six days of each week. The trial does not show which part of this regimen may have contributed to the findings.
What research is needed next?
Further trials are needed to examine the findings in larger groups, test how long any effects last, and clarify the appropriate dose, duration and timing. Researchers also need to establish whether imaging changes correspond to meaningful clinical benefits.
Source: rss
