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From the Buffalo Neuroimaging Analysis Center (R.Z., K.H., N.A., M.S., M.D., S.H., J.D.), The Jacobs Neurological Institute (R.Z., B.W.-G., M.R.), and Baird Multiple Sclerosis Center (B.W.-G.), Department of Neurology; and Department of Pharmaceutical Sciences (M.R.), State University of New York, Buffalo, NY.
Address correspondence and reprint requests to Dr. Murali Ramanathan, 427 Cooke Hall, Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY 14203 murali{at}buffalo.edu
Background: Cigarette smoking has been linked to higher susceptibility and increased risk of progressive multiple sclerosis (MS). The effects of smoking on MRI characteristics of patients with MS have not been evaluated.
Objectives: To compare the MRI characteristics in cigarette smoker and nonsmoker patients with MS.
Methods: We studied 368 consecutive patients with MS (age 44.0 ±SD 10.2 years, disease duration 12.1 ± 9.1 years) comprising 240 never-smokers and 128 (34.8%) ever-smokers (currently active and former smokers). The average number of packs per day smoked (±SD) was 0.95 ± 0.65, and the mean duration of smoking was 18.0 ± 9.5 years. All patients obtained full clinical and quantitative MRI evaluation. MRI measures included T1, T2, and gadolinium contrast-enhancing (CE) lesion volumes (LVs) and measures of central, global, and tissue-specific brain atrophy. The associations between smoking status and MRI measurements were assessed in regression analysis.
Results: Smoking was associated with increased Expanded Disability Status Scale (EDSS) scores (p = 0.004). The median EDSS scores (interquartile range) in the ever-smoker group and the active-smoker group were both 3.0 (2.0), compared with 2.5 (2.5) in never-smokers. There were adverse associations between smoking and the lesion measures including increased number of CE lesions (p < 0.001), T2 LV (p = 0.009), and T1 LV (p = 0.003). Smoking was associated with decreased brain parenchymal fraction (p = 0.047) and with increases in the lateral ventricle volume (p = 0.001) and third ventricle width (p = 0.023).
Conclusions: Smoking is associated with increased blood–brain barrier disruption, higher lesion volumes, and greater atrophy in multiple sclerosis.
Abbreviations: BPF = brain parenchymal fraction; CE = contrast-enhancing; CIS = clinically isolated syndromes; EDSS = Expanded Disability Status Scale; GMF = gray matter fraction; LV = lesion volume; LVV = lateral ventricle volume; MS = multiple sclerosis; P-P = probability–probability; PPMS = primary progressive multiple sclerosis; rp = partial correlation; RRMS = relapsing–remitting multiple sclerosis; SE = standard error of slope; SPMS = secondary progressive multiple sclerosis; 3VW = third ventricle width; WMF = white matter fraction.
Supplemental data at www.neurology.org
Supported by the National Multiple Sclerosis Society (RG3743 and a Pediatric MS Center of Excellence Center Grant). The funding sources had no role in the research, analysis, and interpretation or in the preparation of the manuscript.
Disclosure: Author disclosures are provided at the end of the article.
Received February 19, 2009. Accepted in final form May 1, 2009.
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  E. A. Yeh, B. Weinstock-Guttman, M. Ramanathan, D. P. Ramasamy, L. Willis, J. L. Cox, and R. Zivadinov Magnetic resonance imaging characteristics of children and adults with paediatric-onset multiple sclerosis Brain, November 5, 2009; (2009) awp278v1. [Abstract] [Full Text] [PDF]
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