Smoking And Outcome From Traumatic Brain Injury

1
Smoking And Outcome From Traumatic Brain Injury

• Olli Tenovuo
• Department of Neurology
• University of Turku
• Finland

2
Introduction

• The cholinergic system is known to be frequently
  involved in the chronic sequels of TBI.
• Nicotine is a strong modulator of the cholinergic
  system.

3
Purpose of the study

• To study
• whether smoking history is connected with the
  outcome from TBI,
• whether the response to cholinergic drugs depends
  on the smoking history in victims of TBI.

4
Material and methods

• A questionnaire concerning the smoking and
  drinking history, the eventual response to
  cholinergic drugs and the subjective outcome from
  TBI was sent to all TBI patients included in a
  database of 1029 patients, treated at a
  neurological outpatient university clinic after
  1.1.1993.

5
Material and methods, continued

• In total, 531 patients responded.
• Data on injury severity (measured with Glasgow
  Coma Scale and duration of posttraumatic amnesia)
  and outcome (measured with the Glasgow Outcome
  Scale, extended version GOS-E) were collected
  from the medical records.

6
Results

• Those who had smoked at the time of injury (n
  216) were significantly younger (p lt 0.001).
• The smokers showed a poorer outcome measured with
  the GOS-E, also after taking into account TBI
  severity and age (p 0.03).
• The subjective recovery between the smokers and
  non-smokers did not differ (p 0.11)

7
Results, continued

• One-fourth (24 ) of the smokers felt that the
  effect of smoking had changed due to the injury.
• In 83 of these the effect had become more
  negative, and 25 of those who had smoked at the
  time of injury had stopped smoking afterwards.

8
Results, continued

• The tolerance for alcohol had decreased in 52
  and increased in 5 of those who had used
  alcohol after the injury (n 424).
• After the injury, 11 had stopped and 36 had
  reduced their alcohol consumption, but in 16
  consumption had increased.

9
Results, continued

• Altogether 28 of patients had tried cholinergic
  medication, but the treatment response was very
  similar in both smokers and non-smokers (p
  0.71).

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Discussion

• These results suggest that smoking at the time of
  injury may have a negative influence on the
  outcome of TBI.
• TBI frequently lowers the tolerance for tobacco,
  and especially for alcohol.
• Many TBI patients stop smoking and drinking after
  the injury, and although altered financial status
  may have an effect, the lowered tolerance has an
  apparent influence.
• The treatment response to cholinergic stimulation
  does not seem to depend on smoking history.

11
Discussion, continued

• In theory, modulation of the cholinergic system
  by smoking could affect the brains ability to
  recover
• This study suggests that this may hold true in
  humans, but the eventual realtionship may also be
  indirect (e.g. smokers having more abuse problems
  or lower education and thus lower cognitive
  reserve)