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Smoking is a risk factor for early conversion to clinically definite multiple sclerosis

Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

M Reindl

Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

R Ehling

Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

F Schautzer

Department of Neurology, County Hospital, Villach, Austria

C Gneiss

Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

A Lutterotti

Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

EJ O'Reilly

Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA

KL Munger

Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA

F Deisenhammer

Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

A Ascherio

Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA

T Berger

Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria thomas.berger{at}i-med.ac.at

Background

Cigarette smoking increases the risk for development of multiple sclerosis and modifies the clinical course of the disease. In this study, we determined whether smoking is a risk factor for early conversion to clinically definite multiple sclerosis after a clinically isolated syndrome.

Methods

We included 129 patients with a clinically isolated syndrome, disseminated white-matter lesions on brain magnetic resonance imaging, and positive oligoclonal bands in the cerebrospinal fluid. The patients' smoking status was obtained at the time of the clinically isolated syndrome.

Results

During a follow-up time of 36 months, 75% of smokers but only 51% of non-smokers developed clinically definite multiple sclerosis, and smokers had a significantly shorter time interval to their first relapse. The hazard ratio for progression to clinically definite multiple sclerosis was 1.8 (95% confidence interval, 1.2–2.8) for smokers compared with non-smokers (P = 0.008).

Conclusions

Smoking is associated with an increased risk for early conversion to clinically definite multiple sclerosis after a clinically isolated syndrome, and our results suggest that smoking is an independent but modifiable risk factor for disease progression of multiple sclerosis. Therefore, it should be considered in the counseling of patients with a clinically isolated syndrome.

Key Words: clinically isolated syndrome • disease progression • multiple sclerosis • smoking

This version was published on September 1, 2008

Multiple Sclerosis, Vol. 14, No. 8, 1026-1030 (2008)
DOI: 10.1177/1352458508093679


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