Clinical Study A Randomised Controlled Trial of Efficacy of Cognitive Rehabilitation in Multiple Sclerosis: A Cognitive, Behavioural, and MRI Study J. Campbell, 1 D. Langdon, 2 M. Cercignani, 1 and W. Rashid 3 1 Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, UK 2 Department of Psychology, Royal Holloway, University of London, London, UK 3 Department of Neurology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Correspondence should be addressed to J. Campbell; jcampbell@talk21.com Received 21 July 2016; Revised 29 October 2016; Accepted 17 November 2016 Academic Editor: Malgorzata Kossut Copyright © 2016 J. Campbell et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim. To explore the efcacy of home-based, computerised, cognitive rehabilitation in patients with multiple sclerosis using neuropsychological assessment and advanced structural and functional magnetic resonance imaging (fMRI). Methods. 38 patients with MS and cognitive impairment on the Brief International Cognitive Assessment for MS (BICAMS) were enrolled. Patients were randomised to undergo 45 minutes of computerised cognitive rehabilitation using RehaCom sofware ( = 19) three times weekly for six weeks or to a control condition ( = 19). Neuropsychological and MRI data were obtained at baseline (time 1), following the 6-week intervention (time 2), and afer a further twelve weeks (time 3). Cortical activations were explored using fMRI and microstructural changes were explored using quantitative magnetisation transfer (QMT) imaging. Results. Te treatment group showed a greater improvement in SDMT gain scores between baseline and time 2 compared to the control group ( = 0.005). Te treatment group exhibited increased activation in the bilateral prefrontal cortex and right temporoparietal regions relative to control group at time 3 ( < 0.05 FWE corrected ). No signifcant changes were observed on QMT. Conclusion. Tis study supports the hypothesis that home-based, computerised, cognitive rehabilitation may be efective in improving cognitive performance in patients with MS. Clinical trials registration is ISRCTN54901925. 1. Introduction Cognitive impairment is present in 40–65% of individuals with MS [1]. Studies have shown cognitive defcits (in partic- ular defcits in information processing speed, concentration, and working memory) to be present in the early stages of MS [2–4]. Cognitive impairment has a negative impact on quality of life (QOL) independent of physical symptoms [5, 6]. Tere exists mounting evidence for neuroplasticity as a mechanism to compensate for accumulating pathology in MS and some tentative evidence that cognitive rehabilitation may be efective in preserving or improving cognitive function in patients with MS [7–9]. Computer-assisted cognitive rehabilitation has the potential to provide a structured and standardised approach to rehabilitation. RehaCom is one par- ticular type of sofware designed and utilised for treatment of cognitive impairment in a number of disease states such as stroke, brain injury, and psychiatric disorders [10, 11]. It has been used in a growing number of trials of cognitive rehabilitation in MS as a more standardised intervention [8, 9, 12, 13]. Te difculty level of the computerised tasks adapts to an individual’s performance, only increasing in difculty in response to improving performance. Few studies have examined the structural basis of cog- nitive rehabilitation and longitudinal studies are relatively lacking [8, 14]. Animal data suggest that myelination is, at least in part, regulated by neuronal activity [15]. It is therefore conceivable that techniques, such as magnetisation transfer Hindawi Publishing Corporation Neural Plasticity Volume 2016, Article ID 4292585, 9 pages http://dx.doi.org/10.1155/2016/4292585