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Smoking And Outcome From Traumatic Brain Injury. Olli Tenovuo Department of Neurology University of Turku Finland. 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.

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smoking and outcome from traumatic brain injury

Smoking And Outcome From Traumatic Brain Injury

Olli Tenovuo

Department of Neurology

University of Turku

Finland

introduction
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.
purpose of the study
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.
material and methods
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.

material and methods continued
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.
results
Results
  • Those who had smoked at the time of injury (n = 216) were significantly younger (p < 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)
results continued
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.
results continued8
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.
results continued9
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).
discussion
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.
discussion continued
Discussion, continued
  • In theory, modulation of the cholinergicsystemby smoking couldaffect the brain’sability to recover
  • Thisstudysuggeststhatthismayholdtrue in humans, but the eventualrealtionshipmayalsobeindirect (e.g. smokershavingmoreabuseproblemsorlowereducation and thuslowercognitivereserve)