Tobacco Smoking Increases MS Risk, Autism Risk Increased in Pediatric Stroke, Zolgensma Improves Bulbar Function

Neurology News Network for the week ending March 26, 2022. [WATCH TIME: 4 minutes]

WATCH TIME: 4 minutes

This week Neurology News Network covered a study evaluating the risk of multiple sclerosis in smokers vs non-smokers, the increased risk of autism following pediatric stroke, and the positive impact Zolgensma has on bulbar function in symptomatic SMA.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio.

According to findings from a recently published case-control study, tobacco smoking, a modifiable environmental factor, is linked with the risk of multiple sclerosis (MS) and is most likely causal. Based on this concept, the study indicated that at least 13% of cases of MS could be prevented through the avoidance of tobacco smoking. the study included 9419 individuals with MS participating in 2 large Swedish cohorts and 9419 controls matched for age, gender, and residential area at the time of disease diagnosis. “Smokers” were defined as those who had ever smoked cigarettes regularly before MS onset or the equivalent age in controls. In total, 44.1% of persons with MS and 35.9% of controls had ever smoked prior to disease onset or index age. At the time of MS onset, 38.1% of cases and 29.2% of controls were still smoking (current smokers). The overall AF of MS because of smoking was 13.1% (95%, 10.7-15.4). Women, whom made up 72% of the population, had an AF of 10.6% (95% CI, 7.4-13.7), while men demonstrated an AF of 19.1%.

In a cohort study that spanned almost 50 years, investigators found a 3-fold increased risk of autism after pediatric stroke, an even greater risk observed in individuals with comorbid epilepsy. These findings could not be explained by being born preterm, being small for gestational age, or having a first-degree relative with autism.Using Swedish registries, Sundelin and colleagues identified 1322 indexed individuals with ischemic stroke who were younger than 18 years, alive 1 week after stroke, and were without prior autism. Each child with ischemic stroke was compared with 10 controls matched for sex, year of birth, and country of residence. After excluding children who died within the first week after stroke or diagnosed with autism before their stroke, 1322 index individuals and 13,193 controls remained. Of index individuals with ischemic stroke, 46 (3.5%) were diagnosed with autism compared with 161 (1.2%) controls, corresponding to an adjusted HR (aHR) of 3.02.

Newly published post hoc data from the phase 1 START study and phase 3 STR1VE-US and STR1VE-EU studies showed that Zolgensma helped patients with symptomatic spinal muscular atrophy (SMA) type 1 achieve good bulbar function, a swallowing and speech problem commonly reported by this patient group.Although there is no widely accepted definition for bulbar function in SMA, investigators defined it as the ability to orally communicate with comprehension by an unknown listener and swallow to orally meet nutritional needs while maintaining airway protection. Presented at the 2022 Muscular Dystrophy Association (MDA) Clinical and Scientific Conference, March 13-16, in Nashville, Tennessee, the data included 65 patients who were younger than 6 months of age at the time of administration. At the end of the analysis, 95% (19 of 20) of patients met the communication end point, 92% (60 of 65) had evidence of normal swallow, and 92% (60 of 65) had no aspiration or pneumonia aspiration event reported. Overall, 80% (16 of 20) achieved the composite end point of achieving all 3 outcomes.

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