Smoking Cessation Slows Brain Volume Loss in Multiple Sclerosis

Compared to those who continued smoking, those who stopped experienced a significant decline in the rate of brain volume loss.

BARCELONA — Smoking cessation appears to decelerate loss of brain volume in multiple sclerosis (MS), and may have an effect on long-term clinical outcomes, data presented in a poster session at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress in Barcelona indicate.

In previous research, Ramanujam et al found that for each additional year of smoking after MS diagnosis, conversion to secondary-progressive MS was accelerated by 4.7%. In this study, Navid Seraji-Bozoergzad, MD, assistant professor of neurology at Wayne State University School of Medicine, and colleagues studied the effect of smoking cessation on brain volume in patients with MS.

For the retrospective analysis, the researchers used 3T MRI scans to compare percent change in brain volume (SIENA) in MS patients who stopped smoking and those who continued to smoke. Overall, 254 patients (mean age, 32.8 years) with relapsing-remitting MS were included in the study, all of whom smoked cigarettes for more than five years. Mean disease duration was 4.8 years, duration of disease-modifying treatment was 2.5 years, and EDSS score was 1.7. At baseline, T2 lesion load was 8.2 ml, mean CEL was 0.7, and mean brain volume was 1,521 ml. No significant differences between the groups were observed at baseline.

Percent brain volume change (PBVC) measured by SIENA was done in two phases; phase I from baseline scan to year four scan during which both groups continued to smoke; and phase II, which was from year four scan to year six, during which one group continued to smoke and the other group stopped smoking.  Among the 254 participants, 148 continued to smoke while 106 ceased smoking.

Annual PBVC in the smoking group was -0.54 in phase I and -0.51 in phase II (P= 0.036), compared to -0.55 in phase I and -0.38 in phase II (P< 0.0001) in the group who stopped smoking. Compared to those who continued to smoke throughout phase II, patients who stopped smoking experienced a significant decline in the rate of brain volume loss (PBVC: -0.38 vs. -0.51, P< 0.0001).

“Cessation of smoking should be actively counseled to patients with MS and should be included as a covariate in studies examining brain atrophy in MS,” the study authors wrote, noting that further investigation to examine long-term clinical outcomes is warranted.

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  1. Seraji-Bozoergzad N et al. Abstract P994. Presented at: The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress; Oct. 7-10, 2015; Barcelona.