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Sumelahti ML, Verkko A, Kytö V, Sipilä JOT. Stable excess mortality in a multiple sclerosis cohort diagnosed 1970-2010. Eur J Neurol 2024:e16480. [PMID: 39258870 DOI: 10.1111/ene.16480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/29/2024] [Accepted: 08/28/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is associated with excess mortality. The use of disease-modifying treatments (DMTs) has recently been associated with survival benefits. METHODS A regional MS database was linked with national registries. People with MS (pwMS) diagnosed in 1971-2010 were included and followed up until the end of the year 2019. Five matched controls were acquired for every person with MS. DMTs included in the analyses were interferon and glatiramer acetate. RESULTS Median follow-up time of the 1795 pwMS was 20.0 years (range 0.1-48.7 years). Survival did not differ between decades of diagnosis (p = 0.20). Amongst pwMS, male sex (adjusted hazard ratio [aHR] 1.70; 95% confidence interval [CI] 1.41-2.06), higher age at diagnosis (aHR 1.83; 95% CI 1.65-2.03 per 10-year increment) and primary progressive disease course (aHR 1.29; 95% CI 1.04-1.60) were independently associated with poorer survival. DMT use was associated with better survival (p < 0.0001) and better survival during follow-up (aHR 0.56; 95% CI 0.38-0.81). Compared to matched controls, median life expectancy was 8-9 years shorter in pwMS with survival diverging from controls during the first decade after diagnosis, more clearly in men than women. CONCLUSION Despite DMT use being associated with better survival, relative life expectancy of pwMS did not change over five decades in Western Finland. Male sex was an independent risk factor for death amongst pwMS, but excess mortality was higher in women. More work and methods are needed to improve survival in pwMS.
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Affiliation(s)
- M-L Sumelahti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - A Verkko
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - V Kytö
- Research Services, Turku University Hospital and Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - J O T Sipilä
- Department of Neurology, North Karelia Central Hospital, Siun Sote, Joensuu, Finland, and Clinical Neurosciences, University of Turku, Turku, Finland
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Carnero Contentti E, Rojas JI, Giachello S, Henestroza P, Lopez PA. Smoking and Health-Related Quality of Life in Patients With Multiple Sclerosis From Latin America. Int J MS Care 2024; 26:187-193. [PMID: 39072226 PMCID: PMC11273276 DOI: 10.7224/1537-2073.2023-053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND Tobacco smoking is an important, modifiable, environmental risk factor for multiple sclerosis (MS) with a relevant impact on health-related quality of life (HRQOL). We aimed to assess the use of tobacco in individuals with MS from Latin America (LATAM), and its impact on HRQOL. METHODS We conducted a cross-sectional study based on a LATAM web-based survey. Demographics, social and clinical data, information on physical disability, and HRQOL scores were collected using the MS Impact Scale-29 (MSIS-29), the Fatigue Severity Scale (FSS), and the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Individuals with MS were classified at the time of the survey as follows: never-smokers (ie, patients who reported they had never smoked), past smokers (those who had smoked tobacco but not during the past year), or current smokers. For the analysis, groups were compared. RESULTS 425 patients (74.6% female) from 17 LATAM countries were included, mean age 43.6 ± 11 years and median Expanded Disability Status Scale score 2. There were 122 (28.7%) current smokers, 178 (41.9%) past smokers, and 125 (30.4%) never-smokers. Current smokers had significantly higher MSIS-29 physical (physical worsening), FSS (fatigue), and HADS-A (anxiety) scores compared with past and never-smokers after being adjusted for covariables. No significant differences were observed in any of the other analyzed demographic, clinical, and therapeutic variables. Thirty percent of the current and past smokers groups had never had their neurologists discuss smoking cessation with them. CONCLUSIONS Individuals with MS who were current smokers had higher fatigue and anxiety scores and worse HRQOL compared with past and never-smokers.
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Affiliation(s)
- Edgar Carnero Contentti
- From the Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan I. Rojas
- From the Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Susana Giachello
- From the Asociación de Lucha Contra la Esclerosis Múltiple, Buenos Aires, Argentina
| | - Paula Henestroza
- From the Asociación de Lucha Contra la Esclerosis Múltiple, Buenos Aires, Argentina
| | - Pablo A. Lopez
- From the Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
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3
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Wahbeh F, Restifo D, Laws S, Pawar A, Parikh NS. Impact of tobacco smoking on disease-specific outcomes in common neurological disorders: A scoping review. J Clin Neurosci 2024; 122:10-18. [PMID: 38428126 DOI: 10.1016/j.jocn.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
Although the association of smoking with the risk of incident neurological disorders is well established, less is known about the impact of smoking and smoking cessation on outcomes of these conditions. The objective of this scoping review was to synthesize what is known about the impact of smoking and smoking cessation on disease-specific outcomes for seven common neurological disorders. We included 67 studies on the association of smoking and smoking cessation on disease-specific outcomes. For multiple sclerosis, smoking was associated with greater clinical and radiological disease progression, relapses, risk for disease-related death, cognitive decline, and mood symptoms, in addition to reduced treatment effectiveness. For stroke and transient ischemic attack, smoking was associated with greater rates of stroke recurrence, post-stroke cardiovascular outcomes, post-stroke mortality, post-stroke cognitive impairment, and functional impairment. In patients with cognitive impairment and dementia, smoking was associated with faster cognitive decline, and smoking was also associated with greater cognitive decline in Parkinson's disease, but not motor symptom worsening. Patients with amyotrophic lateral sclerosis who smoked faced increased mortality. Last, in patients with cluster headache, smoking was associated with more frequent and longer cluster attack periods. Conversely, for multiple sclerosis and stroke, smoking cessation was associated with improved disease-specific outcomes. In summary, whereas smoking is detrimentally associated with disease-specific outcomes in common neurological conditions, there is growing evidence that smoking cessation may improve outcomes. Effective smoking cessation interventions should be leveraged in the management of common neurological disorders to improve patient outcomes.
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Affiliation(s)
- Farah Wahbeh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Restifo
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Sa'ad Laws
- Education and Research, Health Sciences Library, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Anokhi Pawar
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
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Krause N, Derad C, von Glasenapp B, Riemann-Lorenz K, Temmes H, van de Loo M, Friede T, Asendorf T, Heesen C. Association of health behaviour and clinical manifestation in early multiple sclerosis in Germany - Baseline characteristics of the POWER@MS1 randomised controlled trial. Mult Scler Relat Disord 2023; 79:105043. [PMID: 37839367 DOI: 10.1016/j.msard.2023.105043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Receiving a multiple sclerosis (MS) diagnosis is a significant stressor. Therefore, highly individualised counselling is needed, especially in early MS. Modifiable risk factors (e.g. smoking and obesity) are gaining relevance in MS. Despite evidence for worse MS-related health outcomes, prevalence of adverse health behaviours, such as smoking and physical inactivity, is high across all MS stages. However, knowledge regarding health behaviours as well as their association with MS-related health outcomes among newly diagnosed PwMS in Germany is scarce. Currently, the efficacy of an interactive digital lifestyle management application intended to be used as an add-on to standard care among newly diagnosed PwMS in Germany is evaluated in an ongoing multicentre randomised controlled trial (RCT) ('POWER@MS1'). OBJECTIVES To describe baseline disease characteristics and health behaviours of the POWER@MS1 cohort and investigate associations between MS characteristics, quality of life (QOL), health behaviours and intention to optimise health behaviour habits. METHODS This study included 234 persons with early MS from 20 study centres located across Germany who participate in the POWER@MS1 RCT. Participants were recruited by treating neurologists from different regions and health-care settings in Germany. Baseline data was obtained using paper-based questionnaires and a web-based healthy diet screener between July 2019 and end of March 2022 and analysed descriptively. RESULTS In this early MS cohort (mean disease duration 4 months), a screening tool showed severe symptoms of anxiety in 15 % of the participants. Better means for stress management appeared to be particularly relevant for the whole cohort. Moreover, 19 % were current smokers, 15 % were obese and 36 % were insufficiently physically active. On average, participants only moderately adhered to dietary guidelines for recommended intake of key food groups (e.g. vegetables, fruits and fatty marine fish). Higher EDSS scores were associated with approximately 20 % higher T2-lesion burden (rate ratio RR=1.2, p<0.001) and 13 % higher relapse rate (RR=1.13,p=0.02) per EDSS disability level. Moreover, a higher T2-lesion burden was associated with current smoking (RR=0.76, p=0.033), resulting in approximately 24 % less T2-lesions at disease onset among non-smokers. In addition, smoking was associated with unhealthier dietary habits according to lower diet scores (linear regression coefficient β=-1.27, p<0.001). Higher EDSS scores (β=0.19,p<0.001) and higher BMI (β=0.013,p=0.03) were associated with higher HAQUAMS (lower QOL). Further, lower diet scores (β=-0.044,p=0.039) were associated with lower QOL. Moreover, higher HAQUAMS (lower QOL) indicated a higher intention to optimise stress management (β=0.98,p<0.001), physical activity (β=0.74,p=0.046) and sleep behaviour (β=1.82,p<0.001). Further, higher intention to optimise stress management was accounted for by higher EDSS scores (β=0.39,p=0.004) and a higher number of T2-lesions (β=0.029,p=0.015) in this newly diagnosed MS cohort. CONCLUSION Results indicate a clear need for modifications of health behaviours among newly diagnosed PwMS participating in POWER@MS1. Individualised psychological and health behaviour counselling appears to be an important factor in treatment, also for similar early MS cohorts and particularly in those who demonstrate a more severe disease in clinical and MRI metrics.
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Affiliation(s)
- Nicole Krause
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany.
| | - Carlotta Derad
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Barbara von Glasenapp
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society, Federal Association, Hannover, Germany
| | - Markus van de Loo
- German Multiple Sclerosis Society, Federal Association, Hannover, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany
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Alrouji M, Manouchehrinia A, Aram J, Alotaibi A, Alhajlah S, Almuhanna Y, Alomeir O, Shamsi A, Gran B, Constantinescu CS. Investigating the Effect of Cigarette Smoking on Serum Uric Acid Levels in Multiple Sclerosis Patients: A Cross Sectional Study. Brain Sci 2023; 13:brainsci13050800. [PMID: 37239272 DOI: 10.3390/brainsci13050800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES The present study is aimed at determining the effect of cigarette smoking (CS) on serum uric acid (UA) levels quantitatively before and after smoking cessation among people with MS (pwMS). Additionally, a possible correlation between UA levels and both disability progression and disease severity was also investigated. A retrospective cross-sectional study was conducted using the Nottingham University Hospitals MS Clinics database. It involves 127 people with definite MS recorded when reporting the latest smoking status and the clinical diagnosis. All necessary demographics and clinical characteristics were collected. We found that smoker pwMS had significantly lower serum UA levels than non-smoker pwMS (p-value = 0.0475), and this reduction was recovered after smoking cessation (p-value = 0.0216). However, the levels of disability or disease severity were not correlated with the levels of serum UA in current smoker pwMS, measured by the expanded disability status scale (EDSS; r = -0.24; p-value = 0.38), multiple sclerosis impact scale 29 (MSIS-29; r = 0.01; p-value = 0.97) and MS severity score (MSSS; r = -0.16; p-value = 0.58), respectively. Our result suggests that the reduction in UA levels is more likely a consequence of oxidative stress triggered by many risk factors, including CS, and could be considered a potential indicator of smoking cessation. In addition, the absence of a correlation between UA levels and disease severity and disability suggests that UA is not an optimal biomarker for disease severity and disability prediction among current smoker, ex-smoker or non-smoker pwMS.
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Affiliation(s)
- Mohammed Alrouji
- Clinical Neurosciences Group, Shaqra University, Shaqra 11961, Saudi Arabia
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Clinical Medical Laboratories, College of Applied Medical Sciences, Shaqra University, Sahqra 11961, Saudi Arabia
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institute, 171 77 Solna, Sweden
| | - Jehan Aram
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Abdulmajeed Alotaibi
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Sharif Alhajlah
- Clinical Neurosciences Group, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Yasir Almuhanna
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Othman Alomeir
- Clinical Neurosciences Group, Shaqra University, Shaqra 11961, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Anas Shamsi
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Bruno Gran
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Cooper University Hospital, Cooper Neurological Institute, Camden, NJ 08103, USA
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Effectiveness of first generation disease-modifying therapy to prevent conversion to secondary progressive multiple sclerosis. Mult Scler Relat Disord 2022; 68:104220. [PMID: 36242804 DOI: 10.1016/j.msard.2022.104220] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) has been associated with reduced relapse rates and accumulation of disability. However, studies examining impact of DMT on risk of transition to secondary progressive MS (SPMS) leveraging population-based nationwide data are still rare. Here, we determine the population incidence of conversion to SPMS using two consecutive nation-wide cohorts, one immediately before and one after the introduction of DMT in Sweden. METHODS We included two consecutive population cohorts of relapsing-remitting MS (RRMS) from the Swedish national MS register for the periods 1975-1994 (n = 2161), before DMT availability, and 1995-2011 (n = 3510), in which DMTs, mainly first generation DMT (injectables), became available and eventually were used by 70% of patients. We explored the risk of transition to SPMS as a calendar year function encompassing the two cohorts. In addition, we determined the incidence of transition to SPMS through age strata below and above 50 years in untreated and treated patient subgroups. RESULTS The risk of conversion to SPMS (adjusted for current age, current time since onset, calendar year and sex) was significantly lower in the second compared with the first population cohort (hazard ratio 0.58; CI 0.48, 0.70). The risk of SPMS conversion per calendar year decreased by 2.6% annually (p < 0.001) after 1995. The risk of SPMS conversion increased with age until age 50. Thereafter, it was unchanged or decreased among those with early MS onset age (<35 years), but continued to increase with onset at higher age, with similar trends in treated and untreated subgroups. CONCLUSION The incidence of SPMS conversion significantly decreased at the population level after introduction of first generation DMTs by 1995. DMT efficiency was confirmed by a downward turn of the annual trajectory of the risk of SPMS conversion after 1995. An onset age determined pattern of variable SPMS incidence in higher age appeared in both treated and untreated strata. While first generation DMT delayed conversion to SPMS, their long-term effect was only moderate.
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Willumsen JS, Grytten N, Aarseth J, Myklebust TÅ, Myhr KM, Midgard R. Mortality and cause of death in multiple sclerosis in western Norway 1950-2021: a registry-based linkage study. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329169. [PMID: 36096665 PMCID: PMC9606487 DOI: 10.1136/jnnp-2022-329169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) have higher risk of mortality compared with the general population. Longitudinal studies are important for understanding the evolution of survival in pwMS. OBJECTIVE Examine changes in mortality among pwMS during the past seven decades. METHODS We followed pwMS from Hordaland and Møre and Romsdal in Western Norway, with disease onset from before 1950, identified from population-based epidemiological surveys and the Norwegian MS Registry and Biobank, until 1 January 2021. Data were linked to the Norwegian Cause of Death Registry to obtain underlying cause of death. We examined all-cause, and cause-specific mortality using standardised mortality ratios (SMR) and excess death rates (EDR). We calculated life expectancies and assessed survival stratified by sex, age and disease phenotype at onset. We compared hazard ratios (HRs) for mortality, in pwMS diagnosed before and after the era of disease-modifying treatment (DMT). RESULTS Of 3624 pwMS, 964 (55.5% women) had died, predominantly of multiple sclerosis (49.0%). Median life expectancy for pwMS was 74.3 years (95% CI 73.3 to 75.3), compared with 83.1 years for the general population (p<0.001). From disease onset, pwMS survived 14.6 years shorter than the general population (p<0.001). Overall, SMR was 2.3 (95% CI 2.13 to 2.42) and EDR was 6.8 (95% CI 6.42 to 7.09) for pwMS. Treatment-eligible pwMS diagnosed in the DMT era had the lowest risk of mortality, HR 0.49 (95% CI 0.34 to 0.70,p<0.001). CONCLUSION Excess mortality among pwMS declined during the past seven decades, possibly due to improved diagnostics, better symptomatic treatment and access to DMTs.
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Affiliation(s)
- Johannes Sverre Willumsen
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Grytten
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
| | - Jan Aarseth
- Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
- Norwegian MS Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Neurology, Haukeland Universitetssjukehus, Bergen, Norway
| | - Rune Midgard
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
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Weld-Blundell I, Grech L, Borland R, White SL, das Nair R, Marck CH. Smoking habits, awareness and support needs for cessation among people with multiple sclerosis in Australia: findings from an online survey. BMJ Open 2022; 12:e059637. [PMID: 35906060 PMCID: PMC9345070 DOI: 10.1136/bmjopen-2021-059637] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To assess smoking habits, nicotine use, exposure to passive smoking, awareness of associated harms, and experiences with and preferences for smoking cessation support among people with multiple sclerosis (MS). DESIGN Online survey, convenience sampling. SETTING Community setting, Australia. PARTICIPANTS Adults living in Australia with probable or diagnosed MS were recruited via social media and newsletters to participate in 2020. RESULTS Of the 284 participants in our convenience sample, 25.7% were current smokers (n=73) and 38.0% were former smokers (n=108). Awareness of the harms of smoking on MS onset (n=68, 24.3%) and progression (n=116, 41.6%) was low. Almost a quarter (n=67, 23.8%) of participants were regularly exposed to passive smoke, and awareness of associated harm was also low (n=47, 16.8%). Among current smokers, 76.1% (n=54) had tried quitting and 73.2% considered quitting within 6 months (n=52). Many participants reported perceived short-term benefits of smoking, and long-term benefits of quitting, on MS symptoms and general well-being (short-term n=28, 40.0%; long-term n=28, 82.4%). While most participants reported that their neurologist (n=126, 75.4%) or other healthcare providers (n=125, 74.9%) had assessed smoking status, very few neurologists (n=3, 1.8%) or other healthcare providers (n=14, 8.4%) had provided help with quitting. Most current smokers preferred speaking about smoking to a neurologist (n=36, 52.2%) or general practitioner (n=41, 59.4%). Almost 60% of the current smokers wanted additional cessation information specific to MS (n=41, 59.4%), and 45.5% said this information would motivate them to quit smoking (n=30). CONCLUSIONS Our convenience sample, which may not be representative, indicated an urgent need for regular evidence-based smoking cessation supports for people with MS. Most participants felt they would benefit from smoking cessation advice. MS clinicians, in collaboration with patient organisations, smoking cessation services and general practitioners, should make smoking cessation promotion with people with MS a priority.
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Affiliation(s)
- Isabelle Weld-Blundell
- Disability and Health Unit, Centre for Health Equity, the Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Grech
- Medicine Monash Health, Monash University, Clayton, Victoria, Australia
| | - Ron Borland
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Sarah L White
- Quit, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Roshan das Nair
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottingham, UK
- Health Services Research, SINTEF, Trondheim, Norway
| | - Claudia H Marck
- Disability and Health Unit, Centre for Health Equity, the Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Smyrke N, Dunn N, Murley C, Mason D. Standardized mortality ratios in multiple sclerosis: Systematic review with meta-analysis. Acta Neurol Scand 2022; 145:360-370. [PMID: 34820847 DOI: 10.1111/ane.13559] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To perform a meta-analysis of all-cause, cause-specific and gender-specific standardized mortality ratio and crude mortality rate for people with multiple sclerosis. We also examined the temporal trends in this data. METHODS Medline, Cochrane Library and Scopus were searched. Keywords were "multiple sclerosis" and "standardized mortality ratio" or "Standardized Mortality Ratio". We included longitudinal studies with available data on the number of deaths, follow-up period, person years and reports of standardized mortality ratio (SMR). Crude mortality ratio (CMR) was calculated and SMR was extracted. CMRs and log-SMR were pooled by the method of inverse variance. Meta-regression models were used to investigate temporal trends. RESULTS Fifty-seven articles were screened. Fifteen studies were included covering a period 1949-2013 (160,000 patients; 21,225 deaths). The all-cause SMR for people with MS was 2.61 (95% CI 2.58 to 2.65). For men this was 2.47 (95% CI 2.42 to 2.52) and for women 2.57 (95% CI 2.53 to 2.61). The CMR was 13.45/1000 person years. Cause-specific SMR was 1.74 (1.67 to 1.81) for CVD, 4.70 (4.45 to 4.87) for respiratory disease and infection, 1.81 (1.64 to 2.0) for accident and suicide and 0.99 (0.93 to 1.06) for cancer. Meta-regression analysis of the SMR compared to midpoint follow-up year revealed no relationship (co-efficient 0.001, p = .98). CONCLUSIONS People with multiple sclerosis (MS) have reduced overall survival and increased risk of death from cardiovascular, respiratory and infectious disease as well as accidents and suicide. This does not appear to have changed over the last 65 years.
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Affiliation(s)
- Natasha Smyrke
- School of Medicine and Surgery University of Auckland Auckland New Zealand
| | - Nicky Dunn
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Center for Molecular Medicine Stockholm Sweden
| | - Chantelle Murley
- Division of Insurance Medicine Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Deborah Mason
- Department of Neurology Christchurch Hospital Christchurch New Zealand
- New Zealand Brain Research Institute Christchurch New Zealand
- Department of Medicine University of Otago Christchurch New Zealand
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10
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Rodgers J, Friede T, Vonberg FW, Constantinescu CS, Coles A, Chataway J, Duddy M, Emsley H, Ford H, Fisniku L, Galea I, Harrower T, Hobart J, Huseyin H, Kipps CM, Marta M, McDonnell GV, McLean B, Pearson OR, Rog D, Schmierer K, Sharrack B, Straukiene A, Wilson HC, Ford DV, Middleton RM, Nicholas R. The impact of smoking cessation on multiple sclerosis disease progression. Brain 2021; 145:1368-1378. [PMID: 34623418 PMCID: PMC9128822 DOI: 10.1093/brain/awab385] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
The negative impact of smoking in multiple sclerosis is well established; however, there is much less evidence as to whether smoking cessation is beneficial to progression in multiple sclerosis. Adults with multiple sclerosis registered on the United Kingdom Multiple Sclerosis Register (2011–20) formed this retrospective and prospective cohort study. Primary outcomes were changes in three patient-reported outcomes: normalized Multiple Sclerosis Physical Impact Scale (MSIS-29-Phys), normalized Multiple Sclerosis Walking Scale (MSWS-12) and the Hospital Anxiety and Depression Scale (HADS). Time to event outcomes were clinically significant increases in the patient-reported outcomes. The study included 7983 participants; 4130 (51.7%) of these had ever smoked, of whom 1315 (16.5%) were current smokers and 2815/4130 (68.2%) were former smokers. For all patient-reported outcomes, current smokers at the time of completing their first questionnaire had higher patient-reported outcomes scores indicating higher disability compared to those who had never smoked (∼10 points difference in MSIS-29-Phys and MSWS-12; 1.5–1.8 points for HADS-Anxiety and HADS-Depression). There was no improvement in patient-reported outcomes scores with increasing time since quitting in former smokers. Nine hundred and twenty-three participants formed the prospective parallel group, which demonstrated that MSIS-29-Phys [median (IQR) 5.03 (3.71, 6.34)], MSWS-12 [median (IQR) 5.28 (3.62, 6.94)] and HADS-Depression [median (IQR) 0.71 (0.47, 0.96)] scores worsened over a period of 4 years, whereas HADS-Anxiety remained stable. Smoking status was significant at Year 4; current smokers had higher MSIS-29-Phys and HADS-Anxiety scores [median (IQR) 3.05 (0.22, 5.88) and 1.14 (0.52, 1.76), respectively] while former smokers had a lower MSIS-29-Phys score of −2.91 (−5.03, −0.79). A total of 4642 participants comprised the time to event analysis. Still smoking was associated with a shorter time to worsening event in all patient-reported outcomes (MSIS-29-Phys: n = 4436, P = 0.0013; MSWS-12: n = 3902, P = 0.0061; HADS-Anxiety: n = 4511, P = 0.0017; HADS-Depression: n = 4511, P < 0.0001). Worsening in motor disability (MSIS-29-Phys and MSWS-12) was independent of baseline HADS-Anxiety and HADS-Depression scores. There was no statistically significant difference in the rate of worsening between never and former smokers. When smokers quit, there is a slowing in the rate of motor disability deterioration so that it matches the rate of motor decline in those who have never smoked. This suggests that smoking cessation is beneficial for people with multiple sclerosis.
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Affiliation(s)
- Jeff Rodgers
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Frederick W Vonberg
- Department of Cellular and Molecular Neuroscience, Imperial College London, W12 0NN, UK
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Alasdair Coles
- Cambridge Neuroscience, University of Cambridge, Cambridge, CB2 3EL, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom WC1B 5EH.,National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, W1T 7HA, UK
| | - Martin Duddy
- Neurosciences, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Hedley Emsley
- Lancaster Medical School, Faculty of Health & Medicine, Lancaster University.,Lancaster, UK & Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, PR1 2HE, UK
| | - Helen Ford
- Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX
| | | | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Timothy Harrower
- Royal Devon and Exeter NHS Trust, Barrack Road, Exeter, EX25DW, UK
| | - Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, Consultant Neurologist, University Hospitals Plymouth, Room N13 ITTC Building, Plymouth Science Park, Davy Road, Plymouth, Devon, PL6 8BX, UK
| | - Huseyin Huseyin
- Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Christopher M Kipps
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Monica Marta
- Neurology - Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea SS0 0RY, UK.,Blizard Institute, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | | | - Brendan McLean
- The Royal Cornwall Hospitals NHS Trust, Treliske, Truro TR1 3LJ, UK
| | - Owen R Pearson
- Swansea Bay University Health Board, Swansea, SA6 6NL, UK
| | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Klaus Schmierer
- Blizard Institute, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK.,Clinical Board Medicine (Neuroscience), Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Basil Sharrack
- Department of Neurology and NIHR Neurosciences Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust and University of Sheffield, Sheffield, S10 2JF, UK
| | - Agne Straukiene
- Torbay and South Devon NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - Heather C Wilson
- National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1H 3BG, UK
| | - David V Ford
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
| | - Rod M Middleton
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
| | - Richard Nicholas
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK.,Department of Cellular and Molecular Neuroscience, Imperial College London, W12 0NN, UK.,Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, EC1V 9RL, UK
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11
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Hunter A, Grech LB, Borland R, das Nair R, White SL, Marck CH. Barriers and motivators for tobacco smoking cessation in people with multiple sclerosis. Mult Scler Relat Disord 2021; 54:103085. [PMID: 34175666 DOI: 10.1016/j.msard.2021.103085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking is a key modifiable risk factor for health outcomes of people with multiple sclerosis (MS). Little evidence exists on whether the information and support needs of people with MS who smoke are met. This study aimed to explore knowledge, attitudes and beliefs about smoking and quitting, and quitting support needs in Australian people with MS. METHODS Current and recent smokers were recruited for phone interviews through social media and newsletters. Interview data were analysed in NVivo using framework analysis. RESULTS We interviewed 25 people with MS (20 current and five recent smokers). Many participants had little knowledge about the risks of smoking on MS progression. Some reported perceived benefits from smoking on MS symptoms, while others perceived smoking worsening their symptoms. Similarly, quitting was believed to have health benefits, but concerns about withdrawal symptoms and the impact on MS symptoms and relapses were common. Participants reported ambivalence discussing smoking with clinicians; some wanting more information and support, while also feeling shame or guilt. Many participants were asked about their smoking status by MS clinicians, however, the provision of evidence-based information, and referrals to quitting support services was very infrequent. General practitioners were often found helpful and supportive, but participants gave more weight to quit advice from MS clinicians. CONCLUSION Our results are the first to indicate that smoking cessation needs of Australian people with MS are not met. These findings should be confirmed in a larger sample, but there is potential to investigate whether implementing routine provision of brief advice in MS care, as a coordinated effort between MS researchers, practitioners, consumer advocates and behavioural intervention services, may meet these needs. Further, developing targeted resources and training quit counsellors to provide appropriate information and support specific to people with MS may improve smoking cessation success in people with MS.
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Affiliation(s)
- Assunta Hunter
- Disability and Health Unit, Centre for Health Equity, The Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lisa B Grech
- Department of Health Sciences, Swinburne University, Melbourne, Australia; Melbourne School of Psychological Sciences, the University of Melbourne, Melbourne, Australia Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, United Kingdom; Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Clinical Sciences at Monash Health, Medicine, Nursing and Health Sciences, Monash University
| | - Ron Borland
- Melbourne School of Psychological Sciences, the University of Melbourne, Melbourne, Australia Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, United Kingdom; Cancer Council Victoria, Melbourne, Australia; The Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia
| | - Roshan das Nair
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, United Kingdom; Institute of Mental Health, Nottingham, United Kingdom
| | - Sarah L White
- Quit Victoria, Cancer Council Victoria, Melbourne, Australia
| | - Claudia H Marck
- Disability and Health Unit, Centre for Health Equity, The Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
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12
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El-Muzaini H, Akhtar S, Alroughani R. A matched case-control study of risk factors associated with multiple sclerosis in Kuwait. BMC Neurol 2020; 20:64. [PMID: 32085743 PMCID: PMC7033919 DOI: 10.1186/s12883-020-01635-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Genetic and environmental factors seem to have etiologic roles in multiple sclerosis (MS). Kuwait is regarded as medium to high risk country for MS. However, there is a paucity of published data on the risk factors for MS in Kuwait. Therefore, this matched case-control study examined the association between various factors including family history, stressful life events, exposure to tobacco smoke, vaccination history, comorbidities and MS risk in Kuwait. Methods Confirmed 110 MS cases and age (± 5 years), gender and nationality matched controls (1:1) were enrolled. A pre-tested structured questionnaire was used to collect the data through face-to-face interviews both from cases and controls. Conditional logistic regression was used to analyze the data. Results Among both cases and controls, majority were Kuwaiti (82.7%), and female (76.4%). Multivariable model showed that cases compared to controls were significantly more likely to have had a family history of MS (adjusted matched odds ratio (mORadj) = 5.1; 95% CI: 2.1–12.4; p < 0.001) or less likely to have been vaccinated against influenza A and B viruses before MS onset (mORadj = 0.4; 95% CI: 0.2–0.8; p = 0.010). None of the other variables considered were significantly related to MS status in this study. Conclusions Family history of MS had significantly direct, whereas, vaccination against influenza A and B viruses had inverse associations with MS status. Future studies may contemplate to verify the observed results.
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Affiliation(s)
- Hadeel El-Muzaini
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, University of Kuwait, PO Box 24923, 13110, Safat, Kuwait.
| | - Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, University of Kuwait, PO Box 24923, 13110, Safat, Kuwait
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Arabian Gulf Street, 13041, Sharq, Kuwait
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13
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Tanasescu R, Constantinescu CS, Tench CR, Manouchehrinia A. Smoking Cessation and the Reduction of Disability Progression in Multiple Sclerosis: A Cohort Study. Nicotine Tob Res 2019; 20:589-595. [PMID: 28402456 DOI: 10.1093/ntr/ntx084] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 04/06/2017] [Indexed: 01/22/2023]
Abstract
Background Smoking is associated with a more severe disease course in people with multiple sclerosis (MS). The magnitude of effect of smoking cessation on MS progression is unknown. The aim of this study was to quantify the impact of smoking cessation on reaching MS disability milestones. Aims and Methods This is a cross-sectional study with retrospective reports. A comprehensive smoking questionnaire was sent to 1270 patients with MS registered between 1994 and 2013 in the Nottingham University Hospital MS Clinics database. Demographic and clinical data were extracted from the clinical database. Cox proportional hazard regression was used to estimate effects of smoke-free years on the time to Expanded Disability Status Scale (EDSS) scores 4.0 and 6.0. MS Impact Scale 29 and Patient Determined Disease Steps were used to assess the physical and psychological impact of smoking. Results Each "smoke-free year" was associated with 0.96 (95% confidence interval: 0.95 to 0.97) times decreased risk of reaching EDSS 4.0 and 0.97 (95% confidence interval: 0.95 to 0.98) times decreased risk of reaching EDSS 6.0. Nonsmokers showed a significantly lower level of disability in all the self-reported outcomes compared with current smokers. Conclusions The reduction in the risk of disability progression after smoking cessation is significant and time dependent. The earlier the patients quit, the stronger the reduction in the risk of reaching disability milestones. The quantitative estimates of the impact of smoking cessation on reaching disability milestones in MS can be used in interventional trials. Implications This study provides for the first time quantitative estimates of the effects of smoking cessation in MS, essential for informing smoking cessation trials. The clear effect of smoking cessation on MS progression suggests the need to consider adjusting for smoking cessation when assessing for treatment effects in clinical trials of treatments for MS. Smoking cessation should be an early intervention in people with MS.
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Affiliation(s)
- Radu Tanasescu
- Academic Clinical Neurology, Division of Clinical Neuroscience, University of Nottingham, UK.,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,Department of Neurology, Colentina Hospital, Bucharest, Romania
| | - Cris S Constantinescu
- Academic Clinical Neurology, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Christopher R Tench
- Academic Clinical Neurology, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
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14
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Chou IJ, Kuo CF, Tanasescu R, Tench CR, Tiley CG, Constantinescu CS, Whitehouse WP. Comorbidity in multiple sclerosis: its temporal relationships with disease onset and dose effect on mortality. Eur J Neurol 2019; 27:105-112. [DOI: 10.1111/ene.14040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- I. J. Chou
- Division of Clinical Neuroscience School of Medicine University of Nottingham Nottingham UK
- Division of Academic Child Health School of Medicine University of Nottingham Nottingham UK
- Division of Paediatric Neurology Chang Gung Memorial Hospital Taoyuan Taiwan
| | - C. F. Kuo
- Division of Rheumatology, Orthopaedics and Dermatology School of Medicine University of Nottingham Nottingham UK
- Division of Rheumatology, Allergy and Immunology Chang Gung Memorial Hospital Taoyuan Taiwan
| | - R. Tanasescu
- Division of Clinical Neuroscience School of Medicine University of Nottingham Nottingham UK
- Division of Neurosciences Department of Neurology Colentina Hospital University of Medicine and Pharmacy Carol Davila Bucharest Romania
| | - C. R. Tench
- Division of Clinical Neuroscience School of Medicine University of Nottingham Nottingham UK
| | - C. G. Tiley
- The Lander Medical Practice Truro Cornwall UK
| | - C. S. Constantinescu
- Division of Clinical Neuroscience School of Medicine University of Nottingham Nottingham UK
| | - W. P. Whitehouse
- Division of Academic Child Health School of Medicine University of Nottingham Nottingham UK
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15
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Marck CH, das Nair R, Grech LB, Borland R, Constantinescu CS. Modifiable risk factors for poor health outcomes in multiple sclerosis: The urgent need for research to maximise smoking cessation success. Mult Scler 2019; 26:266-271. [PMID: 31219393 PMCID: PMC7065446 DOI: 10.1177/1352458519858730] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tobacco smoking is a well-established risk factor for multiple sclerosis (MS) onset, progression and poor health outcomes in people with MS. Despite smoking being a modifiable risk factor, no research has been undertaken to understand how, or who is best placed, to assess or understand smoking behaviour in people with MS, or how healthcare professionals can best assist people with MS to quit. People with MS may have unique motivators to continue smoking, or unique barriers to smoking cessation, that are not addressed by existing cessation tools. Research is urgently needed in this area if the aim is to maximise health outcomes for all people with MS.
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Affiliation(s)
- Claudia H Marck
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Roshan das Nair
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK/Institute of Mental Health, Nottingham, UK
| | - Lisa B Grech
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia/Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia/Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ron Borland
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia/Cancer Council Victoria, Melbourne, VIC, Australia/Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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16
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Lifestyle and Environmental Factors in Multiple Sclerosis. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a028944. [PMID: 29735578 DOI: 10.1101/cshperspect.a028944] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lifestyle and environmental factors potently influence the risk of multiple sclerosis (MS), because genetic predisposition only explains a fraction of the risk increase. There is strong evidence for associations of Epstein-Barr virus (EBV) infection, smoking, sun exposure/vitamin D, and adolescent obesity to risk of MS. There is also circumstantial evidence on organic solvents and shift work, all associate with greater risk, although certain factors like nicotine, alcohol, and a high coffee consumption associate with a reduced risk. Certain factors, smoking, EBV infection, and obesity interact with human leukocyte antigen (HLA) risk genes, arguing for a pathogenic pathway involving adaptive immunity. There is a potential for prevention, in particular for people at greater risk such as relatives of individuals with MS. All of the described factors for MS may influence adaptive and/or innate immunity, as has been argued for MS risk gene variants.
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17
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Effects of cigarette smoke on immunity, neuroinflammation and multiple sclerosis. J Neuroimmunol 2018; 329:24-34. [PMID: 30361070 DOI: 10.1016/j.jneuroim.2018.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 09/30/2018] [Accepted: 10/05/2018] [Indexed: 12/18/2022]
Abstract
Cigarette smoking is the most prominent significant cause of death and morbidity. It is recognised as a risk factor for a number of immune mediated, inflammatory diseases including multiple sclerosis (MS). Here, we review the complex immunological effects of smoking on the immune system, which include enhancement of inflammatory responses with a parallel reduction of some immune defences, resulting in an increased susceptibility to infection and a persistent proinflammatory environment. We discuss the effect of smoking on the susceptibility, clinical course, disability, and mortality in MS, the likely benefits of smoking cessation, and the specific immunological effects of smoking in MS. In conclusion, smoking is an important environmental risk factor for MS occurrence and outcome, and it acts in significant part through immunological mechanisms.
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18
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Harding K, Anderson V, Williams O, Willis M, Butterworth S, Tallantyre E, Joseph F, Wardle M, Pickersgill T, Robertson N. A contemporary study of mortality in the multiple sclerosis population of south east Wales. Mult Scler Relat Disord 2018; 25:186-191. [PMID: 30099203 DOI: 10.1016/j.msard.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/19/2018] [Accepted: 08/01/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mortality studies in multiple sclerosis (MS) are valuable to identify changing disease patterns and inform clinical management. This study examines mortality in a British MS cohort. METHODS Patients were selected from the southeast Wales MS registry. Hazard of death was analysed using Cox proportional hazards regression, adjusted for onset age, annualised relapse rate, initial disease course, time to EDSS 4.0, sex, socioeconomic status, and onset year. Age- and sex-stratified standardised mortality ratios (SMRs) were calculated by EDSS scores. RESULTS Median time from MS diagnosis to death was 35.5 years and median age 73.9. Older onset age (hazard ratio [HR] 1.05, 95% confidence interval 1.03-1.06) was associated with increased hazard of death. Primary progressive course was associated with increased hazard of death in women (HR 2.04, 1.15-3.63) but not men (HR 1.23, 0.61-2.47). Slow time to EDSS 4.0 (HR 0.41, 0.28-0.60) and high socioeconomic status (HR 0.54, 0.37-0.79) were associated with reduced hazard of death. SMR increased from EDSS 6.0 (3.86, 2.63-5.47) but more substantially at EDSS 8.0 (22.17, 18.20-26.75). CONCLUSIONS Risk of death in MS varies substantially with degree of disability. This has important implications for clinical management and health economic modelling.
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Affiliation(s)
- Katharine Harding
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom; Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Valerie Anderson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
| | - Owain Williams
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
| | - Mark Willis
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom; Department of Neurology, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, United Kingdom
| | - Sara Butterworth
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
| | - Emma Tallantyre
- Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
| | - Fady Joseph
- Department of Neurology, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, United Kingdom
| | - Mark Wardle
- Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
| | - Trevor Pickersgill
- Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
| | - Neil Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom; Helen Durham Centre for Neuroinflammatory Disease, Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
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19
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Moffat F, Paul L. Barriers and solutions to participation in exercise for moderately disabled people with multiple sclerosis not currently exercising: a consensus development study using nominal group technique. Disabil Rehabil 2018; 41:2775-2783. [DOI: 10.1080/09638288.2018.1479456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Fiona Moffat
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Paul
- Nursing and Healthcare School, University of Glasgow, Glasgow, UK
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20
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Lavery AM, Collins BN, Waldman AT, Hart CN, Bar-Or A, Marrie RA, Arnold D, O'Mahony J, Banwell B. The contribution of secondhand tobacco smoke exposure to pediatric multiple sclerosis risk. Mult Scler 2018; 25:515-522. [PMID: 29393768 DOI: 10.1177/1352458518757089] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pediatric acquired demyelinating syndromes (ADSs) are monophasic (mono-ADS) in 70% of cases and represent the first attack of multiple sclerosis (MS) in 30%. Secondhand tobacco smoke (SHS) exposure has been implicated as a risk factor for adult-onset MS. Little is known about whether SHS presents an additive risk beyond genetic factors and other environmental exposures associated with pediatric MS. METHODS This study examined SHS exposure in 216 children with mono-ADS and 81 children with MS. Interactions between SHS, HLA-DRB1*15 alleles, serum 25-hydroxyvitamin D concentrations, and serological evidence of remote Epstein-Barr virus (EBV) exposure were evaluated. RESULTS SHS exposure was more common in children with MS (37% exposed) compared to mono-ADS (29.5% exposed). Compared to mono-ADS, SHS exposure was not an independent risk factor for MS. When both SHS exposure and HLA-DRB1*15 were present, the odds for MS increased (odds ratio (OR) = 3.7; 95% confidence interval (CI): 1.17-11.9) compared to mono-ADS. Interactions between SHS and vitamin D or EBV did not associate with MS. CONCLUSION Exposure to SHS is a risk factor for central nervous system (CNS) demyelination. Results suggest that SHS exposure and HLA-DRB1*15 interact to increase risk for MS in children diagnosed with mono-ADS.
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Affiliation(s)
- Amy M Lavery
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA/Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Amy T Waldman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chantelle N Hart
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA/Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Amit Bar-Or
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada/Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Douglas Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Julia O'Mahony
- Institute of Health Policy, Management, and Evaluation, University of Toronto and The Hospital for Sick Children, Toronto, ON, Canada
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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21
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Abstract
PURPOSE OF REVIEW This article reviews the rationale and approach to symptom management and lifestyle modifications in multiple sclerosis (MS). RECENT FINDINGS MS symptoms are important to treat because they affect quality of life and daily activity. Appreciation of cluster symptoms (where one symptom contributes to another), changes over time, and multimodality therapeutic approaches are guiding optimized symptom management. Equally important are lifestyle modifications that enhance central nervous system reserve and function. These modifications are the foundation for a health maintenance, wellness, and vascular risk factor control program. SUMMARY Symptom management and lifestyle modifications are important therapeutic targets to improve the lives of patients with MS.
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Abstract
Multiple sclerosis (MS) is a demyelinating and neurodegenerative disorder of the central nervous system, for which disease modifying therapies (DMTs) are the mainstay treatment approach to reduce inflammatory disease activity and slow worsening disability. In addition to conventional pharmacologic therapy, there is growing interest in the use of lifestyle strategies to support wellness and mitigate disease-related complications in MS. This interest stems from a growing appreciation of the role of certain comorbidities and lifestyle factors on disease activity, disability, mortality, and overall quality of life. While the current literature is not conclusive, there is evidence to suggest a potential role for vitamin D supplementation, tobacco smoking cessation, routine exercise, a plant-based, anti-inflammatory diet, and maintenance of emotional well-being as adjunct therapies to DMTs. In addition to DMTs, lifestyle strategies should be emphasized as part of a management plan focused on overall health and well-being.
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Affiliation(s)
- Brandon P Moss
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
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Iridoy Zulet M, Pulido Fontes L, Ayuso Blanco T, Lacruz Bescos F, Mendioroz Iriarte M. Epigenetic changes in neurology: DNA methylation in multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Williams WV. Hormonal contraception and the development of autoimmunity: A review of the literature. LINACRE QUARTERLY 2017; 84:275-295. [PMID: 28912620 PMCID: PMC5592309 DOI: 10.1080/00243639.2017.1360065] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Estrogens and progestins are known to have profound effects on the immune system and may modulate the susceptibility to autoimmune diseases. A comprehensive literature search was carried out using PubMed for any of 153 autoimmune disease terms and the terms contraception, contraceptive, or their chemical components with limits of Humans + Title or Abstract. Over 1,800 titles were returned and scanned, 352 papers retrieved and reviewed in depth and an additional 70 papers retrieved from the bibliographies. Based on this review, substantial evidence exists linking the use of combined oral contraceptives to a lower incidence of hyperthyroidism, an increase in multiple sclerosis, ulcerative colitis, Crohn's disease, Systemic Lupus Erythematosus, and interstitial cystitis. Progesterone only contraceptives are linked to progesterone dermatitis and in one large developing world concurrent cohort study are associated with increases in arthropathies and related disorders, eczema and contact dermatitis, pruritis and related conditions, alopecia, acne, and urticaria. Hormonal contraceptives modulate the immune system and may influence the susceptibility to autoimmune diseases with significant increases in risk for several autoimmune diseases. SUMMARY Hormonal contraceptives (HCs), such as the "pill," Norplant, and vaginal rings, are very potent hormones that have effects on the immune system, which is made up of white blood cells and lymph nodes and normally defends the body against invading bacteria, viruses and parasites. This review looked at the association of HC use to the development of autoimmune diseases, where the immune system turns against the body and causes damage to organs. There is good evidence that HC use is associated with an increased risk of several serious autoimmune diseases such as Crohn's disease (which causes inflammation of the bowels), Lupus (which causes inflammation in many organs), and interstitial cystitis (which causes inflammation in the bladder). Several other rarer autoimmune diseases are also linked to HC use. People contemplating the use of HCs should be informed of these risks.
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Affiliation(s)
- William V Williams
- BriaCell Therapeutics Corporation, Havertown, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
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25
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Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis. Nat Rev Neurol 2016; 13:25-36. [PMID: 27934854 DOI: 10.1038/nrneurol.2016.187] [Citation(s) in RCA: 653] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Genetic predisposition to multiple sclerosis (MS) only explains a fraction of the disease risk; lifestyle and environmental factors are key contributors to the risk of MS. Importantly, these nongenetic factors can influence pathogenetic pathways, and some of them can be modified. Besides established MS-associated risk factors - high latitude, female sex, smoking, low vitamin D levels caused by insufficient sun exposure and/or dietary intake, and Epstein-Barr virus (EBV) infection - strong evidence now supports obesity during adolescence as a factor increasing MS risk. Organic solvents and shift work have also been reported to confer increased risk of the disease, whereas factors such as use of nicotine or alcohol, cytomegalovirus infection and a high coffee consumption are associated with a reduced risk. Certain factors - smoking, EBV infection and obesity - interact with HLA risk genes, pointing at a pathogenetic pathway involving adaptive immunity. All of the described risk factors for MS can influence adaptive and/or innate immunity, which is thought to be the main pathway modulated by MS risk alleles. Unlike genetic risk factors, many environmental and lifestyle factors can be modified, with potential for prevention, particularly for people at the greatest risk, such as relatives of individuals with MS. Here, we review recent data on environmental and lifestyle factors, with a focus on gene-environment interactions.
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Salter A, Tyry T, Wang G, Fox RJ, Cutter G, Marrie RA. Examining the joint effect of disability, health behaviors, and comorbidity on mortality in MS. Neurol Clin Pract 2016; 6:397-408. [PMID: 27847682 DOI: 10.1212/cpj.0000000000000269] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In multiple sclerosis (MS), comorbidities have been associated with disability progression and an increased risk of mortality. We investigated the association between comorbidities and mortality in MS after accounting for disability and health behaviors. METHODS We followed North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants who completed the Fall 2006 survey on comorbidities until death (reported or matched in the National Death Index) or date of last follow-up in 2014. We used proportional hazards regression to investigate the association between comorbidities and mortality, controlling for demographic, clinical, health behavior, and disability factors. RESULTS Of 9,496 participants meeting the inclusion criteria, 502 (5.3%) were deceased. Most participants reported having ≤3 comorbid conditions (70.9% survivors, 76.9% decedents). In individual regression models, vascular, visual, and mental comorbidities were associated with increased mortality risk after adjustment for factors associated with survival. When combined into a single model, vascular (hazard ratio 1.269; 1.041-1.547), visual (1.490; 1.199-1.852), and mental comorbidities (excluding anxiety, 1.239; 1.024-1.499) remained independently associated with an increased risk of mortality. CONCLUSIONS Presence of comorbidities was independently associated with an increased risk of mortality as compared to absence of comorbidities after adjusting for factors associated with survival. Specifically, vascular, visual, and mental comorbidities increased the risk of mortality. This highlights the need for clinicians to attend to these comorbidities, which can be modified by treatments or other interventions, and potentially reduce the risk of mortality in persons with MS who have these conditions.
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Affiliation(s)
- Amber Salter
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Tuula Tyry
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Guoqiao Wang
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Robert J Fox
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Gary Cutter
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- Division of Biostatistics (AS, GW), Washington University in St. Louis, MO; Division of Neurology (TT), Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Neurology and Neurological Institute (RJF), Cleveland Clinic, OH; Department of Biostatistics (GC), University of Alabama at Birmingham; and Departments of Internal Medicine and Community Health Sciences (RAM), University of Manitoba, Winnipeg, Canada
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Perricone C, Versini M, Ben-Ami D, Gertel S, Watad A, Segel MJ, Ceccarelli F, Conti F, Cantarini L, Bogdanos DP, Antonelli A, Amital H, Valesini G, Shoenfeld Y. Smoke and autoimmunity: The fire behind the disease. Autoimmun Rev 2016; 15:354-74. [DOI: 10.1016/j.autrev.2016.01.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/31/2015] [Indexed: 12/14/2022]
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Manouchehrinia A, Tanasescu R, Tench CR, Constantinescu CS. Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios. J Neurol Neurosurg Psychiatry 2016; 87:324-31. [PMID: 25935887 DOI: 10.1136/jnnp-2015-310361] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There are inconsistent data on mortality in people with multiple sclerosis (MS). We performed a meta-analysis of all-cause, cause-specific and gender-specific crude mortality rates (CMRs), and standardised mortality ratios (SMRs) in MS, and estimated the rate of change of CMR and SMR over the past 50 years. METHODS Medline, Embase and the Cochrane Library were searched. KEYWORDS 'Multiple Sclerosis' and ('standardised mortality' or 'standardized mortality'). INCLUSION CRITERIA availability of data on the number of deaths; mean or median patient follow-up or reports of SMRs; being a longitudinal study. 12 studies were included covering the period 1949-2012 (27 423 patients; 6628 deaths; 437 832 person-years follow-up). CMR was calculated. SMRs were extracted. CMRs and natural logarithm of SMRs were pooled by the method of the inverse of the variance. Meta-regression models were used to investigate the secular trends. RESULTS Pooled CMR was 9.78/1000 person-years (95% CI 6.81 to 14.02). Pooled all-cause SMR was 2.80 (95% CI 2.74 to 2.87). All-cause SMR was 2.56 (95% CI 2.47 to 2.66) in males and 3.06 (95% CI 2.97 to 3.17) in females. SMR due to cancer was 0.89 (95% CI 0.83 to 0.97). SMRs due to cardiovascular diseases, suicide, infection and respiratory diseases were 1.29 (95% CI 1.20 to 1.38), 2.13 (95% CI 1.80 to 2.51) and 2.91 (95% CI 2.60 to 3.26). There was no trend in CMRs, all-cause, and gender-specific SMRs. CONCLUSIONS The excess mortality in MS relative to the general population has not changed over the past 50 years. Female patients with MS have higher survival disadvantage compared to that of males. Death due to cardiovascular diseases, suicide and infection is higher in patients with MS compared to the general population.
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Affiliation(s)
- Ali Manouchehrinia
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Radu Tanasescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK Department of Neurology, Neurosurgery and Psychiatry, University of Medicine and Pharmacy Carol Davila, Colentina Hospital, Bucharest, Romania
| | - Christopher R Tench
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Weston M, Constantinescu CS. What role does tobacco smoking play in multiple sclerosis disability and mortality? A review of the evidence. Neurodegener Dis Manag 2016; 5:19-25. [PMID: 25711451 DOI: 10.2217/nmt.14.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is increasing evidence of tobacco smoking as an associative factor in multiple sclerosis (MS). Numerous studies have been conducted investigating the effects of smoking before the onset of MS as well as its impact on disease course. This special report reviews the available evidence and summarizes the contribution of smoking to increased mortality in patients with MS. It also explores some putative mechanisms for the involvement of tobacco constituents in the pathology of MS and the effects of smoking on disease-modifying treatments.
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Affiliation(s)
- Mikail Weston
- Academic Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Aliomrani M, Sahraian MA, Shirkhanloo H, Sharifzadeh M, Khoshayand MR, Ghahremani MH. Blood Concentrations of Cadmium and Lead in Multiple Sclerosis Patients from Iran. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2016; 15:825-833. [PMID: 28243279 PMCID: PMC5316261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since industrial revolution heavy metals such as lead (Pb) and cadmium (Cd) have been extensively dispersed in environment which, unknown biological effects and prolong biological half-life make them as a major hazard to human health. In addition, the sharp increase in Multiple sclerosis incidence rateshas been recorded in Iran. The propose of this study was to measuring blood lead and cadmium concentration and their correlation with smoking habit in a group of 69 RRMS patients and 74 age/gender-matched healthy individuals resident in Tehran as most polluted city in Iran. All subjects were interviewed regarding age, medical history, possible chemical exposure, acute or chronic diseases, smoking and dietary habits. Blood Pb and Cd levels were measured by double beam GBC plus 932 atomic absorption spectrometer. Our result indicated a significant difference in Cd level (p = 0.006) in which, MS patients had higher blood concentration (1.82 ± 0.13 μg/L) in comparison with healthy individuals (1.47 ± 0.11 μg/L). A comparable blood Cd level to similar recent study (1.78 µg/L vs.1.82 µg/L) was observed. With respect to Pb there was no significant difference between cases and controls, however the geometric means of blood Pb concentration were considerably higher in males than in females in MS patients (57.1 ± 33.7 μg/L vs. 36.7 ± 21.9 μg/L. P = 0.02). Taking into consideration tobacco smoking, an elevated contents of each metal were observed in smoker subjects (p<0.0001). A significant correlation between cigarette smoking and risk of multiple sclerosis was shown before. Thus, high level of Cd in smokers might affect the susceptibility to multiple sclerosis and could increase the risk of disease development.
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Affiliation(s)
- Mehdi Aliomrani
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tehran University of Medical Sciences.
| | - Mohammad Ali Sahraian
- MS Research Center, Department of Neurology, school of Medicine, Tehran University of Medical Sciences.
| | - Hamid Shirkhanloo
- Iranian Petroleum Industry Health Research Institute (IPIHRI), Tehran, Iran.
| | - Mohammad Sharifzadeh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tehran University of Medical Sciences.
| | - Mohammad Reza Khoshayand
- Department of Drug & food control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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Manouchehrinia A, Edwards LJ, Roshanisefat H, Tench CR, Constantinescu CS. Multiple sclerosis course and clinical outcomes in patients with comorbid asthma: a survey study. BMJ Open 2015; 5:e007806. [PMID: 25995241 PMCID: PMC4442191 DOI: 10.1136/bmjopen-2015-007806] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine if comorbid asthma is associated with accumulation of multiple sclerosis (MS)-related impairment and disability. METHOD We sent a comprehensive questionnaire to a cohort of patients with MS and examined the association between comorbid asthma and reaching Expanded Disability Status Scale (EDSS) scores 4.0 and 6.0. Multiple Sclerosis Impact Scale (MSIS-29) scores were compared between patients with MS with and without comorbid asthma. RESULTS 680 patients participated in our study of whom 88 (12.9%) had comorbid asthma. There was no difference in the prevalence of asthma between our MS cohort and the England general population (OR: 0.89, 95% CI 0.68 to 1.17). We did not observe a significant association between having asthma and the risk of reaching EDSS scores 4.0 and 6.0 (HR: 1.29, 95% CI 0.93 to 1.77, and HR: 1.33, 95% CI 0.93 to 1.89, respectively) after controlling for confounders. Patients with MS with asthma reported higher level of psychological impairments (coefficient: 2.29, 95% CI 0.1 to 4.49). CONCLUSIONS Asthma is a prevalent condition among patients with MS and it may contribute to the psychological impairment in MS. Although we did not observe significant association between comorbid asthma and physical disability in MS, it seems that the two conditions influence one another.
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Affiliation(s)
- Ali Manouchehrinia
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Laura J Edwards
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Homayoun Roshanisefat
- Department of Clinical Neuroscience, CMM; Karolinska Institute, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Christopher R Tench
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Iridoy Zulet M, Pulido Fontes L, Ayuso Blanco T, Lacruz Bescos F, Mendioroz Iriarte M. Epigenetic changes in neurology: DNA methylation in multiple sclerosis. Neurologia 2015; 32:463-468. [PMID: 25976949 DOI: 10.1016/j.nrl.2015.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/19/2015] [Accepted: 03/05/2015] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Epigenetics is defined as the study of the mechanisms that regulate gene expression without altering the underlying DNA sequence. The best known is DNA methylation. Multiple Sclerosis (MS) is a disease with no entirely known etiology, in which it is stated that the involvement of environmental factors on people with a genetic predisposition, may be key to the development of the disease. It is at this intersection between genetic predisposition and environmental factors where DNA methylation may play a pathogenic role. DEVELOPMENT A literature review of the effects of environmental risk factors for the development of MS can have on the different epigenetic mechanisms as well as the implication that such changes have on the development of the disease. CONCLUSION Knowledge of epigenetic modifications involved in the pathogenesis of MS, opens a new avenue of research for identification of potential biomarkers, as well as finding new therapeutic targets.
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Affiliation(s)
- M Iridoy Zulet
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - L Pulido Fontes
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Navarrabiomed-Fundación Miguel Servet, Pamplona, Navarra, España
| | - T Ayuso Blanco
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - F Lacruz Bescos
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M Mendioroz Iriarte
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Navarrabiomed-Fundación Miguel Servet, Pamplona, Navarra, España.
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Roshanisefat H, Bahmanyar S, Hillert J, Olsson T, Montgomery S. All-cause mortality following a cancer diagnosis amongst multiple sclerosis patients: a Swedish population-based cohort study. Eur J Neurol 2015; 22:1074-80. [DOI: 10.1111/ene.12710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/06/2015] [Indexed: 01/09/2023]
Affiliation(s)
- H. Roshanisefat
- Department of Neurology; Karolinska University Hospital Huddinge; Stockholm Sweden
- Neuroimmunology Unit; Department of Clinical Neuroscience and Centre for Molecular Medicine; Karolinska Institute and Karolinska University Hospital; Solna Sweden
| | - S. Bahmanyar
- Clinical Epidemiology Unit and Centre for Pharmacoepidemiology; Department of Medicine; Karolinska University Hospital and Karolinska Institute; Stockholm Sweden
- Faculty of Medicine; Golestan University of Medical Sciences; Gorgan Iran
| | - J. Hillert
- Department of Neurology; Karolinska University Hospital Huddinge; Stockholm Sweden
- Neuroimmunology Unit; Department of Clinical Neuroscience and Centre for Molecular Medicine; Karolinska Institute and Karolinska University Hospital; Solna Sweden
| | - T. Olsson
- Neuroimmunology Unit; Department of Clinical Neuroscience and Centre for Molecular Medicine; Karolinska Institute and Karolinska University Hospital; Solna Sweden
| | - S. Montgomery
- Clinical Epidemiology Unit and Centre for Pharmacoepidemiology; Department of Medicine; Karolinska University Hospital and Karolinska Institute; Stockholm Sweden
- Clinical Epidemiology and Biostatistics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Research Department of Epidemiology and Public Health; University College London; London UK
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