Multiple sclerosis (MS) is a chronic and destructive inflammatory disease of the central nervous system (CNS) in which inflammation, demyelination, and axonal loss occur from the very early stages of the disease.

MS mainly affects young people, between 20 and 40 years of age, with a female predominance. MS phenotypes were described based on clinical relapse rate and disease progression: relapsing disease (clinically isolated syndrome [CIS], relapsing-remitting MS [RRMS]) and chronic progressive (secondary-progressive MS (SPMS), primary-progressive MS (PPMS). Approximately 85% of patients with MS are initially diagnosed with RRMS, which is characterised by acute periods of dysfunction followed by partial or complete recovery of patients. It usually occurs in early adolescence and develops into secondary progressive MS in approximately half of the patients.

Several studies demonstrated the association between tobacco smoking and higher risk and increased progression of multiple sclerosis (MS). Data about the effect of smoking during the recovery from MS attacks is limited. Furthermore, different types of tobacco exposures such as water pipe and passive smoking are not well assessed separately. Hosseini et al evaluated the effect of different types of smokes, cigarette and water pipe as well as passive smoking on the function recovery of relapsing-remitting MS (RRMS) attacks.

METHODS

This cohort study evaluated the adult patients with RRMS and Expanded Disability Status Scale (EDSS) <5 in the attack phase. Patients were divided into two groups: smokers and non-smokers. The smokers included those who use cigarette, water pipe as well as passive smokers as subgroups for more analyses later. EDSS was monitored after relapse and two months after relapse. Change of EDSS considered as the criteria for functional recovery. The correlation between the amount of consumption and disability level was assessed among smokers by Pearson’s correlation test. While the difference of EDSS between smoker and non-smoker were assessed by Independent samples T-test.

RESULTS

Evaluations were conducted on 142 patients. Approximately 55% were smokers (43% male) while 44% were non-smokers (36% male). There was a statistically significant difference in change of EDSS between smoker and non-smoker groups, which change of EDSS was higher in non-smokers. Also, there was a significantly lesser decline in EDSS after two months in the cigarette smokers in subgroups analyses (P<0.001). A correlation analysis revealed a significant positive correlation between the number per day of cigarette smoking and EDSS after relapse (r= 0.3, P= 0.03) and a significant positive correlation between minutes per month of smoking of water pipe and EDSS two months after relapse (r= 0.6, P>0.001).

CONCLUSION

Tobacco smoking, especially cigarette smoking, is associated with a negative effect on recovery from the attack in patients with RRMS.

REFERENCE

Marie Hosseini, Mahsa Haghighatzadeh, Rezvan Hassanpour, et al. The effects of different types of smoking on recovery from attack in hospitalized Multiple Sclerosis patients. Clinical Neurology and Neurosurgery 2023:107846, ISSN 0303-8467, https://doi.org/10.1016/j.clineuro.2023.107846.