Comment on “Alemtuzumab improves cognitive processing speed in active multiple sclerosis – a longitudinal observational study”

An interesting article was recently read about the effect of alemtuzumab on cognitive impairment (CI) in multiple sclerosis (MS) 1 . This brings up the question whether other highly efficacious treatments can impact CI? If the answer is positive, is it permissible to select an escalation approach? MS is a debilitating disease of central nervous system (CNS), which is common among young adults with notice-able economic consequences on the government 2 . Due to wide-spread distribution of lesions, MS manifests a broad range of the symptoms. CI is one of the most critical symptoms, with prevalence rate ranging from 43 to 70% 3 , embracing all types of clinical courses and disease stages 4 . The evidence suggests that neuropsychological scores are better in relapsing-remitting (RR) patients compared to secondary-progressive (SP) and pri-mary-progressive (PP) cases 5 . Cognitive impairment is more severe in SP patients than in PP patients 6 . Unfortunately, the effect of disease-modifying therapy (DMTs) on cognition is not well known. There is less evidence that DMTs are beneficial to improve the cognition 1 . However, there is still no clear answer to this question: Do high potent DMTs significantly impact CI by slowing and stabilizing the course compared with low potent drugs? Clarification of this issue seems to make a sig-nificant change in treating MS patients. Studies showed a link between CI and brain atrophy. Brain atrophy can be seen in the early stages of MS, which is asso-ciated with a decrease in brain volume and function. It was found that the higher the severity of cognition impairment in the patients, the higher the severity of brain atrophy 7,8 . Previously,