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Modulation of oxidative stress is thus a therapeutic target.14 Antioxidants, such as ascorbic acid and vitamin E, delay or prevent the oxidation of substrates, limiting stress-induced oxidative degradation and promoting cell survival and resistance.12 Some cofactors of the respiratory chain, such as succinate, coenzyme Q10, riboflavin, and thiamine the latter two, components of immunonutrition have been useful in MELAS treatment.8 Once the diagnosis of MELAS was confirmed, intravenous l-carnitine was added to achieve therapeutic doses

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A landmark study by Chen et al

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