Lipoic Acid and Omega-3 Fatty Acids for Cognitive Impairment in Multiple Sclerosis

Treatment tested

• Omega-3 fatty acids

Placebo or sham

• Placebo

Inclusion Criteria: * • A definite diagnosis of multiple sclerosis (MS) with relapsing remitting or secondary progressive course * Age 18 to 65 years, inclusive * A score two or more standard deviations below the mean in one or more of the following cognitive tests: PASAT, COWAT, CVLT -II, Stroop * Expanded Disability Status Scale (EDSS) 0-7.5, inclusive * Suboptimal omega-3 levels (plasma docosahexaenoic acid [DHA] + eicosapentaenoic acid [EPA] \< 5.0% of total plasma fatty acids) * If taking MS disease modifying medications, on stable dose for > 6 months preceding enrollment * Able to read and write English Exclusion Criteria: * • Moderate to severe depression (Beck Depression Inventory score > 19) * Any significant uncontrolled medical problem including diabetes requiring insulin. * MS relapse within the 30 days before screening * Abnormalities of coagulation or current use of prescription anticoagulants or antiplatelet agents. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are not excluded. * Fish intake of one 6 ounce serving > once a week less than 2 months prior to enrollment * Omega-3 fatty acid supplement intake (e.g. fish oil capsules, cod liver oil) less than 2 months prior to enrollment * Lipoic Acid supplementation less than 1 month prior to enrollment * Taking systemic corticosteroids, neuroleptics, antiparkinsonian agents, and/or narcotic analgesics. Low dose sinemet and dopamine agonist taken once a day for restless leg syndrome is not an exclusion. * Contraindications to MRI, including: subjects with intrathecal pumps, stimulators, pacemakers, aneurysm clips, non-removable hearing aids, or metal fragments in the eyes. Other exclusion criteria include the inability to lie flat on the back for 40 minutes at a time or a self-reported history of claustrophobia. Subjects with a history of hip replacement and those with well-documented, verifiable, MRI-safe cardiac stents will not be excluded from the study. * Epilepsy or history of seizures. * Pregnancy or women not using a reliable form of contraception * Corrected binocular visual acuity worse than 20/50 or more than one error on binocular color vision testing with the Ishihara Color plates or sustained nystagmus or diplopia on primary gaze * Inability to complete the neuropsychological test battery at the screening visit * Participation in another intervention study

The primary aim is to collect data to determine the correct effect size on the primary outcome to aid in the design of a larger study: The primary outcome is to determine if lipoic acid and omega-3 fatty acids can improve cognitive function in people with multiple sclerosis that have cognitive dysfunction.