Localized short echo time (TE = 20 ms), stimulated echo acquisition mode, and double spin echo (TE = 135 ms) proton spectroscopy were performed in clearly defined, acute Gadolinium (Gd)-enhancing multiple sclerosis (MS) plaques of 22 patients with clinically definite MS. The resonances of N-acetylated metabolites (NA), creatine/phosphocreatine (Cr), choline-containing compounds (Cho), glycine/myo-inositol (Ino), and lactate were evaluated. The ratios of NA/Cr and NA/Cho were significantly decreased, Cho/Cr increased, and Ino/Cr remained unchanged. No marker peaks or elevated lactate levels were found. The measured metabolic changes were practically independent of the relative plaque size within the volume of interest (8 ml). Thus, the spectral changes measured with 1H MRS in acute Gd-enhancing MS plaques originate not only from the lesion as depicted by MRI, but also from the surrounding normal-appearing white matter.