BUFFALO, N.Y. -- Persons with multiple sclerosis who smoked for
a little as six months during their lifetime had more destruction
of brain tissue and more brain atrophy than MS patients who never
smoked, a study by neuroimaging specialists at the University at
Buffalo has shown.
Research published in the Aug. 18, 2009, issue of
Neurology®, the medical journal of the American Academy
of Neurology, showed that "ever-smokers" had more brain lesions and
greater loss of brain volume, as well as higher scores on the
Expanded Disability Status Scale (EDSS), than MS patients who had
no history of smoking.
The EDSS score is an average number derived from measures of
various functions of the central nervous system. It is based on a
scale from 0 to 10, with 10 representing greatest disability.
Nonsmokers recorded an average EDSS score of 2.5, compared to 3.0
"Cigarette smoking is one of the most compelling environmental
risk factors linked to the development and worsening of MS," said
Robert Zivadinov, M.D., Ph.D., UB professor of neurology, director
of the Buffalo Neuroimaging Analysis Center (BNAC) where the
research was conducted and first author on the study.
"The biological basis of the potential link between smoking and
MS has not yet been fully elucidated," Zivadinov said. "In addition
to nicotine, cigarette smoke contains hundreds of potentially toxic
components, including tar, carbon monoxide and polycyclic aromatic
"In MS patients, smoking was associated with higher increased
lesion burden and greater brain atrophy. Our results indicate that
a wide range of quantitative brain MRI markers are affected by
smoking in MS patients."
The study involved 368 consecutive patients who were seen at the
Baird Multiple Sclerosis Center of the Jacobs Neurological
Institute (JNI), UB's Department of Neurology, UB School of
Medicine and Biomedical Sciences.
Within the study cohort, 128 had a history of smoking: 96 were
active smokers who had smoked more than 10 cigarettes-per-day in
the three months prior to the study start and 32 were former
smokers who had smoked cumulatively for at least six months
sometime in the past. The remaining 240 participants were lifelong
Nearly 80 percent in both groups were female, and nearly 75
percent were diagnosed with progressive MS, characterized by a
steadily increasing disability.
All participants were evaluated by a clinician, were rated by
disability using the EDSS scale and underwent a variety of
high-resolution magnetic resonance imaging (MRI) scans conducted by
MRI analysts who were blinded to the patient's clinical status and
Results showed that smokers with MS had a greater breakdown of
the blood-brain barrier, had nearly 17 percent more brain lesions
-- patches of inflammation in the sheath surrounding the nerve
fibers that impair their function -- than nonsmokers with MS, and
also had less brain volume. Smoking also was associated with
increased physical disability, as measured by the EDSS score.
Bianca Weinstock-Guttman, M.D., director of the Baird MS Center,
UB associate professor of neurology and a principal co-author on
the study, said: "The findings underscore the detrimental effect of
smoking, providing a link between smoking and a more severe brain
injury in MS patients.
"Increased antismoking education in schools and more targeted
smoking cessation programs for patients with MS should be
encouraged further and supported."
Murali Ramanathan, Ph.D., associate professor of pharmaceutical
sciences in the UB School of Pharmacy and Pharmaceutical Sciences,
is senior author on the study. Additional authors, all from UB, are
Komal Hashmi, M.D., Nadir Abdelrahman, M.D., Milena Stosic, M.D.,
Michael G. Dwyer, Sara Hussein and Jackie Durfee.
The research was funded by an independent grant from the BNAC,
by the National Multiple Sclerosis Society and by a Pediatric MS
Center of Excellence Center Grant. The Pediatric MS Center of
Excellence is located in Women and Children's Hospital of Buffalo.
The BNAC is located in Buffalo General Hospital. Both hospitals are
part of Kaleida Health.
The University at Buffalo is a premier research-intensive
public university, a flagship institution in the State University
of New York system and its largest and most comprehensive campus.
UB's more than 28,000 students pursue their academic interests
through more than 300 undergraduate, graduate and professional
degree programs. Founded in 1846, the University at Buffalo is a
member of the Association of American Universities.