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A small randomized trial found that people with mild to moderate multiple sclerosis who received N-acetylcysteine alongside standard care had changes in brain connectivity and glucose metabolism after about four months. Participants also reported improvements in several symptoms, but the study does not establish that NAC is an effective MS treatment or show whether the findings persist.
A small randomized trial of 36 people with mild to moderate multiple sclerosis linked treatment with the antioxidant N-acetylcysteine (NAC) to changes in brain connectivity and glucose metabolism, alongside participants’ reports of symptom improvement. The findings, presented by researchers from Thomas Jefferson University and published in IBRO Neuroscience Reports, are early evidence about possible brain effects, not proof that NAC treats MS.
Researchers 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, along with 500 milligrams orally twice a day on the other six days of each week. Participants in both groups underwent imaging and completed symptom questionnaires at the start and again after four months, with a two-month margin around that interval.
Using resting-state functional MRI, the researchers observed connectivity alterations in the NAC group compared with controls, including in the inferior frontal region, cerebellum, and areas of the temporal and parietal lobes. FDG PET scans showed increased cerebral glucose metabolism in several corresponding areas, including the inferior frontal and inferior temporal gyri. These are imaging findings; by themselves, they do not establish that brain function improved.
Only participants in the NAC group reported improved scores on the measured symptoms after treatment: pain (P=0.015), fatigue (P=0.016), cognition (P=0.036), and attention (P=0.010). The report said self-reported cognitive and attention improvements correlated with imaging changes. The findings do not establish that NAC caused these reported changes, or that the effects would hold in a larger or longer trial.
What the Brain Scans May Add
MS can involve cognitive difficulties as well as physical symptoms, and the trial explored whether an antioxidant approach might relate to brain measures not assessed by symptoms alone. Pairing functional MRI with PET gave researchers a way to examine connectivity and glucose metabolism in the same participants, then compare those results with questionnaire responses.
Study presenter Sahar Darabi Monadi said approved MS treatments largely target inflammation, while oxidative stress is another process researchers are examining. NAC is being studied because it can increase glutathione, a substance involved in the brain’s antioxidant defenses. The present findings may support further research into this approach, but the trial is too small to show whether NAC offers a meaningful clinical benefit or should be added to care.
N-acetylcysteine supplement for MS
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How Researchers Tested NAC
The study assessed whether NAC treatment was associated with changes in measures of oxidative stress and brain function in people with MS. Both groups continued standard care; only the treatment group received the combined intravenous and oral NAC schedule. Researchers selected this combination because, according to co-author Andrew Newberg, previous data suggested oral NAC absorption can vary.
The report places the work within research on NAC in other neurological conditions, including Parkinson’s disease and chronic mild traumatic brain injury. Those studies are not evidence that NAC works for MS. The current trial’s contribution is its simultaneous assessment of resting-state connectivity and cerebral glucose metabolism in people with MS, together with symptom questionnaires.
““The imaging findings seemed to correspond to some of the clinical improvements people were reporting.””
— Andrew Newberg, MD, Thomas Jefferson University
Limits of the Early Findings
The trial included only 36 participants, and the follow-up assessment took place after four months, plus or minus two months. The report does not establish how long any imaging or symptom changes lasted, whether they translate into sustained day-to-day improvements, or whether the results apply to people with more severe MS or different treatment histories.
The symptom outcomes were self-reported, and the reported correlations do not show that imaging changes caused symptom changes. The source also does not provide enough detail to determine the size of the clinical effects or how they compare with changes considered meaningful to patients. Optimal dose, treatment duration, timing, and safety in broader MS populations remain questions for further study. The findings are not a recommendation to start NAC or alter prescribed MS treatment.
Further Trials Must Clarify Treatment
Newberg said the researchers hope the initial results will lead to more detailed study of NAC in MS, including appropriate dosing, duration, and timing. Larger and longer trials would be needed to test whether the brain-scan patterns and questionnaire changes can be reproduced and whether they correspond to durable clinical benefits.
Until such evidence is available, the study supports further investigation rather than a change in MS care. People considering supplements or changes to treatment should discuss them with a qualified health professional.
Key Questions
What is NAC?
N-acetylcysteine is an antioxidant-related compound that can increase glutathione, according to the study presenter. The trial tested it alongside standard care in people with MS.
Did the trial show that NAC treats multiple sclerosis?
No. The small study reported brain-imaging changes and self-reported symptom improvements in the treatment group, but it does not prove that NAC treats MS or establish a clinical benefit.
How many people took part, and what was the treatment schedule?
The randomized trial included 36 people with mild to moderate MS, with 18 assigned to NAC plus standard care. That group received 50 milligrams per kilogram intravenously once weekly and 500 milligrams orally twice daily on the other six days.
Should people with MS start taking NAC based on this study?
The findings do not provide a basis for changing treatment. Anyone considering NAC or another supplement should discuss it with a qualified health professional and should not stop or change prescribed MS medication without medical guidance.
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