Johnen A, Elpers C, Riepl E, et al. - Because cognitive impairment (CI) is a critical characteristic in patients with childhood or juvenile multiple sclerosis (MS), researchers encouraged the understanding of CI and addressed the effect of various pharmacological treatment strategies on cognitive performance in this group of patients. At the initial presentation (baseline) and on average 2.5 years later (follow-up), a cohort of 19 patients with therapy-naïve or ß-interferon-treated juvenile MS finished a thorough neuropsychological evaluation. In those patients whose therapy had not been escalated, a higher impairment frequency was prominent at follow-up, while cognition was preserved or improved in patients whose treatment during the observational period had been escalated to highly effective drugs. Findings suggested an association of paediatric MS with considerable CI already in early disease stages. Although early administration of highly effective therapy may protect against cognitive decline or alleviate CI in juvenile MS, larger controlled trials are warranted to confirm these preliminary results.