The effect of smoking on the symptoms and progression of multiple sclerosis: a review

Shirani, Afsaneh; Tremlett, Helen

doi:10.2147/jir.s12059

Cited by 18 publications

(19 citation statements)

References 155 publications

(191 reference statements)

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“…The documented effect of smoking and hyperlipidaemia on ‘MS-specific’ lesions supports a direct influence on MS pathology, possibly through promotion of acute inflammation 2 8–11. In line with our results, HT12 and DM13 and total VRF5 have failed to show an impact on T2 lesion volume in MS, although MS-specific lesion locations were not studied, and individual VRFs, including smoking, were not adjusted for.…”

Section: Resultssupporting

confidence: 84%

Distinct influence of different vascular risk factors on white matter brain lesions in multiple sclerosis

Geraldes

Juryńczyk

Passos

et al. 2020

J Neurol Neurosurg Psychiatry

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ObjectiveTo determine if vascular risk factor (VRF), that is, smoking, arterial hypertension (HT), dyslipidaemia and diabetes, have an effect on multiple sclerosis (MS) pathology as measured by MS typical brain lesions, we have compared brain MRIs from patients with MS with and without VRF age-matched and sex-matched.MethodsBrain MRIs from five centres were scored for the presence of Dawson’s fingers (DF) and juxtacortical lesions (JCL). A regression model was built to predict the effect of each individual VRF on DF and JCL, considering age and disease duration.Results92 MS cases without VRF and 106 MS with one or more VRF (80 ever-smokers, 43 hypertensives, 25 dyslipidaemics and 10 diabetics) were included. Ever-smoking associated with a higher burden of DF (Exp(B)=1.29, 95% CI 1.10 to 1.51, p<0.01) and JCL (Exp(B)=1.38, 95% CI 1.21 to 1.57, p<0.01). No other VRF had an impact on DF. Dyslipidaemia associated with increased JCL (Exp(B)=1.30, 95% CI 1.10 to 1.56, p<0.01) but HT did not associate with any of the outcomes.ConclusionsIndividual VRF appear to affect MS-specific lesions differently. An increase in MS lesions was mainly seen in smokers; however, this VRF is most likely to be present from onset of MS, and other VRF effects may be partly mitigated by treatment. Our findings support that treating VRF and cessation of smoking may be important in the management of MS.

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Section: Resultssupporting

confidence: 84%

Distinct influence of different vascular risk factors on white matter brain lesions in multiple sclerosis

Geraldes

Juryńczyk

Passos

et al. 2020

J Neurol Neurosurg Psychiatry

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“…Through increased axonal de- With no apparent change in FA, decreased MD in the left corona radiata and superior longitudinal fasciculus of H S may be due to nicotine-related alterations in the WM. The nicotine-induced cytotoxic swelling suggested by Gazdzinski et al (22) and proinflammatory effects of cigarette smoke on tissue as shown by elevated peripheral leukocytes, and recruitment of polymorphonuclear cells, monocytes, macrophages, and increased fibrinogen may be partly responsible for cellular edema and reduced MD levels in the H S of the current study (23). Some recent studies have hypothesized on the neurotropic and promyelinating effects of smoking and have found higher FA in brain regions such as the prefrontal WM, cingulum, and corpus callosum in smokers compared with nonsmokers (9,24).…”

Section: Discussionsupporting

confidence: 48%

“…Additional deteriorating effects of the toxic contents of tobacco smoke such as cyanide, nitric oxide, and free radicals might explain the greater vulnerability of the NAWM in CIS S. The associations between thiocyanate, the main metabolite of cyanide and demyelination in the central nervous system of animals (19), and between nitric oxide and axonal degeneration, blocks in axonal conduction, especially in demyelinated axons (20) With no apparent change in FA, decreased MD in the left corona radiata and superior longitudinal fasciculus of H S may be due to nicotine-related alterations in the WM. The nicotine-induced cytotoxic swelling suggested by Gazdzinski et al (22) and proinflammatory effects of cigarette smoke on tissue as shown by elevated peripheral leukocytes, and recruitment of polymorphonuclear cells, monocytes, macrophages, and increased fibrinogen may be partly responsible for cellular edema and reduced MD levels in the H S of the current study (23). Some recent studies have hypothesized on the neurotropic and promyelinating effects of smoking and have found higher FA in brain regions such as the prefrontal WM, cingulum, and corpus callosum in smokers compared with nonsmokers (9, 24).…”

supporting

confidence: 51%

Influence of cigarette smoking on white matter in patients with clinically isolated syndrome as detected by diffusion tensor imaging

Durhan¹,

Diker²,

Has³

et al. 2016

Diagn Interv Radiol

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C linically isolated syndrome (CIS), an inflammatory demyelinating disorder of the central nervous system, is the first clinical episode with features predictive of multiple sclerosis (MS) (1). Many environmental risk factors for conversion from CIS to MS were shown in recent studies (1,2). Among these, cigarette smoking was shown to increase the risk of developing MS even in passive smokers (3), worsen clinical disability, and exacerbate disease progression (4) .Diffusion tensor imaging (DTI) gives the opportunity to evaluate the tissue integrity, mainly the white matter (WM). Through changes in metrics such as fractional anisotropy (FA) and mean diffusivity (MD), DTI enables the assessment of axonal organization and myelin attenuation in addition to the WM lesions evaluated by conventional magnetic resonance imaging (MRI) sequences (5). The brains of MS patients have demonstrated that an increase in MD and a decrease in FA values were far beyond fluid attenuation inversion recovery (FLAIR) hyperintense lesions, commonly used as a clinical parameter of MS (6, 7). Brain parenchyma with no apparent lesion, namely, the normal-appearing white matter (NAWM), has drawn much attention due to the presence of not only histopathologic and radiologic abnormalities but also a close association with clinical disability and disease progression (8). Changes in the NAWM may also be responsible for the clinicoradiologic discrepancy observed in many patients (6). In addition, several MRI studies have shown significantly altered FA measures in specific brain regions in healthy smoker individuals (9, 10). Although a number of studies have investigated the impact of smoking on patients with MS (4,11), to the best of our knowledge, no study has studied the influence of smoking on the WM in patients with CIS using DTI.In this study we sought to determine the effects of smoking on NAWM, lesions, and perilesional WM of patients with CIS. The secondary objective was to examine whether diffu- PURPOSECigarette smoking has been associated with increased occurrence of multiple sclerosis (MS), as well as clinical disability and disease progression in MS. We aimed to assess the effects of smoking on the white matter (WM) in patients with clinically isolated syndrome (CIS) using diffusion tensor imaging. METHODSSmoker patients with CIS (n=16), smoker healthy controls (n=13), nonsmoker patients with CIS (n=17) and nonsmoker healthy controls (n=14) were included. Thirteen regions-of-interest including nonenhancing T1 hypointense lesion and perilesional WM, and 11 normal-appearing white matter (NAWM) regions were drawn on color-coded fractional anisotropy (FA) maps. Lesion load was determined in terms of number and volume of WM hyperintensities. RESULTSA tendency towards greater lesion load was found in smoker patients. T1 hypointense lesions and perilesional WM had reduced FA and increased mean diffusivity to a similar degree in smoker and nonsmoker CIS patients. Compared with healthy smokers, smoker CIS patients had more extensive NAWM changes...

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“…We demonstrated that cognitive impairment is significantly higher in MS patients that are heavy smokers. Our data are supported by other studies that have shown that smoking worsens MS symptoms 21,22. However, this study is the first to report the effects of smoking on cognition in MS patients.…”

Section: Discussionsupporting

confidence: 91%

Association between smoking and cognitive impairment in multiple sclerosis

Özcan¹,

Ince²,

Bingöl³

et al. 2014

NDT

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PurposeAlthough smoking is known to cause various symptoms in multiple sclerosis (MS) patients, there have been no reports regarding the relationship between smoking and cognitive impairment in MS. Studying the effects of cigarette smoking in MS patients is imperative as there is a high prevalence of cognitive impairment in MS patients. In this study we examined the potentially deleterious effects of heavy smoking on mentation of patients with MS.Patients and methodsMS patients receiving care at the Neurology Clinic at Bezmialem Vakıf University, between the ages of 18–65 years who have at least graduated elementary school were included in the study. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) is a commonly used method to assess cognitive function in MS patients and was utilized in our study. Patients that smoked for at least 10 pack-years were considered heavy smokers.ResultsAll the patients were stratified into two groups: heavy smokers (n=20) and nonsmokers (n=24). For heavy smokers, their cognitive functioning was more impaired than that of nonsmokers (P=0.04, χ2=4.227). For patients with cognitive impairment, 78.9% of the Paced Auditory Serial Addition Test and 63.2% of the Symbol Digit Modalities Test scores were found to be lower.ConclusionPrevious reports have suggested that smoking increases the frequency of relapse among individuals with relapsing-remitting MS and accelerates disease progression in patients with progressive MS. According to the results of our study, heavy smokers had increased cognitive impairment when compared to nonsmokers. Extensive studies are necessary to further elucidate the relationship between smoking and cognitive impairment in MS patients.

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The effect of smoking on the symptoms and progression of multiple sclerosis: a review

Cited by 18 publications

References 155 publications

Distinct influence of different vascular risk factors on white matter brain lesions in multiple sclerosis

Distinct influence of different vascular risk factors on white matter brain lesions in multiple sclerosis

Influence of cigarette smoking on white matter in patients with clinically isolated syndrome as detected by diffusion tensor imaging

Association between smoking and cognitive impairment in multiple sclerosis

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