• Nils Muhlert, Matteo Atzori, Enrico De Vita, David L Thomas, Rebecca S Samson, Claudia A M Wheeler-Kingshott, Jeroen J G Geurts, David H Miller, Alan J Thompson, and Olga Ciccarelli.
• Department of Neuroinflammation, NMR Research Unit, UCL Institute of Neurology, London, UK Cognitive Neuroscience, Department of Psychology, Cardiff University, Cardiff, UK.
• J. Neurol. Neurosurg. Psychiatr.. 2014 Aug 1;85(8):833-9.

ObjectiveGlutamate is the principal excitatory neurotransmitter and is involved in normal brain function. Cognitive impairment is common in multiple sclerosis (MS), and understanding its mechanisms is crucial for developing effective treatments. We used structural and metabolic brain imaging to test two hypotheses: (i) glutamate levels in grey matter regions are abnormal in MS, and (ii) patients show a relationship between glutamate concentration and memory performance.MethodsEighteen patients with relapsing-remitting MS and 17 healthy controls were cognitively assessed and underwent (1)H-magnetic resonance spectroscopy at 3 T to assess glutamate levels in the hippocampus, thalamus, cingulate and parietal cortices. Regression models investigated the association between glutamate concentration and memory performance independently of magnetisation transfer ratio values and grey matter lesions withint he same regions, and whole-brain grey matter volume.ResultsPatients had worse visual and verbal memory than controls. A positive relationship between glutamate levels in the hippocampal, thalamic and cingulate regions and visuospatial memory was detected in patients, but not in healthy controls.ConclusionsThe relationship between memory and glutamate concentration, which is unique to MS patients, suggests the reliance of memory on glutamatergic systems in MS.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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