We report a patient with MELAS treated for 24 months with idebenone and rib
oflavin, during which no stroke-like episodes occurred. Moreover neurologic
al symptoms clearly improved, and a recovery of brain MRI and EEG abnormali
ties was observed. We conclude that the combined treatment with idebenone a
nd riboflavin may restore the metabolic impairment in MELAS, possibly impro
ving the long-term prognosis in these patients.