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Updated: Jun 20, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Smoking is associated with increased lesion volumes and brain atrophy in multiple sclerosis
R Zivadinov1, B Weinstock-Guttman, K Hashmi
1Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, NY 14203, USA.
Background:
Cigarette smoking has been linked to higher susceptibility and increased risk of progressive multiple sclerosis (MS). The effects of smoking on MRI characteristics of patients with MS have not been evaluated.
Objectives:
To compare the MRI characteristics in cigarette smoker and nonsmoker patients with MS.
Methods:
We studied 368 consecutive patients with MS (age 44.0 +/-SD 10.2 years, disease duration 12.1 +/- 9.1 years) comprising 240 never-smokers and 128 (34.8%) ever-smokers (currently active and former smokers). The average number of packs per day smoked (+/-SD) was 0.95 +/- 0.65, and the mean duration of smoking was 18.0 +/- 9.5 years. All patients obtained full clinical and quantitative MRI evaluation. MRI measures included T1, T2, and gadolinium contrast-enhancing (CE) lesion volumes (LVs) and measures of central, global, and tissue-specific brain atrophy. The associations between smoking status and MRI measurements were assessed in regression analysis.
Results:
Smoking was associated with increased Expanded Disability Status Scale (EDSS) scores (p = 0.004). The median EDSS scores (interquartile range) in the ever-smoker group and the active-smoker group were both 3.0 (2.0), compared with 2.5 (2.5) in never-smokers. There were adverse associations between smoking and the lesion measures including increased number of CE lesions (p < 0.001), T2 LV (p = 0.009), and T1 LV (p = 0.003). Smoking was associated with decreased brain parenchymal fraction (p = 0.047) and with increases in the lateral ventricle volume (p = 0.001) and third ventricle width (p = 0.023).
Conclusions:
Smoking is associated with increased blood-brain barrier disruption, higher lesion volumes, and greater atrophy in multiple sclerosis.
Insights
Cigarette smoking is linked to worse outcomes in multiple sclerosis (MS). Smokers show increased disability, more brain lesions, and greater atrophy compared to non-smokers.
Area of Science:
- Neurology
- Radiology
- Public Health
Background:
- Cigarette smoking is a known risk factor for multiple sclerosis (MS) susceptibility and progression.
- The impact of smoking on the magnetic resonance imaging (MRI) characteristics of MS patients remains under-investigated.
Purpose of the Study:
- To investigate and compare MRI findings in cigarette smokers versus non-smokers diagnosed with MS.
- To assess the relationship between smoking status and various MRI-derived measures of disease burden and brain atrophy.
Main Methods:
- A cohort of 368 MS patients (240 never-smokers, 128 ever-smokers) underwent comprehensive clinical and quantitative MRI evaluations.
- MRI assessments included T1, T2, and gadolinium-enhancing (CE) lesion volumes, as well as central, global, and tissue-specific brain atrophy metrics.
- Regression analysis was employed to determine associations between smoking status and MRI outcomes.
Main Results:
- Ever-smokers and active smokers exhibited significantly higher Expanded Disability Status Scale (EDSS) scores compared to never-smokers.
- Smoking was associated with an increased number of CE lesions, greater T2 and T1 lesion volumes.
- Patients who smoked showed reduced brain parenchymal fraction and increased lateral and third ventricle volumes, indicating greater atrophy.
Conclusions:
- Smoking is demonstrably linked to increased blood-brain barrier disruption in MS patients.
- The study confirms a correlation between cigarette smoking and higher lesion volumes and accelerated brain atrophy in multiple sclerosis.
- These findings underscore the detrimental effects of smoking on MS pathology and disease progression.
