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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EFactors such as smoking, obesity, and mental health comorbidities play an important role in the etiology and well-being of patients with multiple sclerosis (MS), as well as their families.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurodevelopmental Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDemyelinating Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurodevelopmental Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDemyelinating Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EFactors such as smoking, obesity, and mental health comorbidities play an important role in the etiology and well-being of patients with multiple sclerosis (MS), as well as their families.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAccording to Ruth Ann Marrie, MD, PhD, University of Manitoba, Winnipeg, Manitoba, Canada, there is growing evidence that smoking may confer \u226450% greater risk in the development of MS, particularly among Caucasian men (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [O\u0027Gorman C, Broadley SA. \u003Cem\u003EJ Neurol\u003C\/em\u003E. 2014]. Some data also suggest that people who begin smoking earlier than age 15 may have a worsened prognosis as the disease progresses [Sundstr\u00f6m P, Nystr\u00f6m L. \u003Cem\u003EMult Scler\u003C\/em\u003E. 2008].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/29\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Meta-analysis of the Association Between Smoking and Multiple Sclerosis\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-898494860\u0022 data-figure-caption=\u0022Meta-analysis of the Association Between Smoking and Multiple Sclerosis\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/29\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/29\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/29\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11865\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EMeta-analysis of the Association Between Smoking and Multiple Sclerosis\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced from O\u0027Gorman C et al. Smoking and multiple sclerosis: evidence for latitudinal and temporal variation. \u003Cem\u003EJ Neurol\u003C\/em\u003E. 2014;261:1677\u20131683. \u003Ca id=\u0022xref-fig-1-2\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E. \u00a9 Springer-Verlag Berlin Heidelberg 2014. With kind permission from Springer Science and Business Media.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EDr Marrie then discussed adolescent obesity as a risk factor for MS. In a Swedish case-control study, people with a body mass index \u0026gt;27 kg\/m\u003Csup\u003E2\u003C\/sup\u003E at age 20 were twice as likely to develop MS when compared with their normal-weight counterparts [Hedstr\u00f6m AK et al. \u003Cem\u003EMult Scler\u003C\/em\u003E. 2012]. In the Nurses\u0027 Health Study, women who self-described themselves as obese at age 18 were at twofold greater risk of MS (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) [Munger KL et al. \u003Cem\u003ENeurology\u003C\/em\u003E. 2009]. Age-adjusted risk for body size at age 20 was associated with a 96% increased risk of MS (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .009). No significant risk was evident for a large body size at age 5 (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .46) or 10 (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .15). Dr Marrie also highlighted a study suggesting that female adolescent obesity increases the risk of developing pediatric MS [Langer-Gould A et al. \u003Cem\u003ENeurology\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EA small percentage of people with MS who are treated with natalizumab develop anti-drug antibodies, which is associated with a suboptimal clinical response [Calabresi PA et al. \u003Cem\u003ENeurology\u003C\/em\u003E. 2007]. Tomas Olsson, MD, PhD, Karolinska Institutet, Stockholm, Sweden, spoke next about the relationship between smoking and the development of these antinatalizumab antibodies.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EData were drawn from 1338 patients with MS who were treated with natalizumab in 2 large ongoing clinical trials [EIMS; GEMS], both of which have collected information on participants\u0027 smoking habits. Treatment-related information was obtained from the Swedish national MS registry and antibody status before the start of therapy and again at 6, 12, and 24 months. Logistic regression was then used to compare the risk of developing antinatalizumab antibodies among smokers versus those who never smoked.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EAmong the 1338 patients, 4.8% developed antibodies to natalizumab [Hedstrom A et al. \u003Cem\u003EMult Scler\u003C\/em\u003E. 2013]. Compared with never smokers, patients who smoked at the time of screening were more than twice as likely to develop antinatalizumab antibodies (OR, 2.4; 95% CI, 1.2 to 4.4; \u003Cem\u003EP\u003C\/em\u003E = .008). For patients who smoked within 2 years of the screening, the odds ratio of developing antinatalizumab antibodies was 2.7 (95% CI, 1.5 to 5.1; \u003Cem\u003EP\u003C\/em\u003E = .001). There was no significant association between people who had stopped smoking at least 2 years prior to screening and the risk of developing the antibodies (\u003Cem\u003EP\u003C\/em\u003E = .09)\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EProf Olsson hypothesized that smoking irritates the lungs, which initiates a reaction that increases the risk of an immune response to natalizumab, as well as interferon \u03b2 and monoclonal antibodies. He closed his session by emphasizing the clinical implications of these findings and highlighting the importance of smoking cessation among people at risk of MS.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EAlthough children who have a parent with a chronic disease may be at risk of developing social, emotional, or behavioral difficulties [Sieh DS et al. \u003Cem\u003EClin Child Fam Psychol Rev.\u003C\/em\u003E 2010], there is little consensus as to whether children who have a parent with MS are at this same risk [Razaz N et al. \u003Cem\u003EBMC Neurol\u003C\/em\u003E. 2014]. Neda Razaz, MPH, University of British Columbia, Vancouver, British Columbia, Canada, described a study designed to examine the association between parental MS and childhood developmental outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThis was a retrospective cohort study that collected data from hospital discharges, pharmacy claims, physician claims, census and income bureaus, and child development data. The outcome of interest was the absence or presence of vulnerability on 5 outcomes of childhood development measured by the Early Development Instrument (EDI) when administered to a child at 5 years of age. The 5 domains of interest were social competence, physical health and well-being, language and cognitive development, emotional maturity, and communication skills.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAmong 3116 adults with MS, 153 had a child who had taken the EDI. These children and their parents were then matched with 876 controls from the general population. The characteristics of the MS group are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11866\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11866\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11866\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003ECharacteristics of Parents with MS, n = 153\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-15\u0022\u003EAdjusted odds ratios were calculated with multivariable logistic regression that adjusted for potential confounders, such as socioeconomic status, maternal age at birth, age of the child when the EDI was administered, number of siblings per child, and whether parents had comorbid mental health issues. Compared with the controls, parents with MS were older at time of childbirth, achieved a higher socioeconomic status, and were significantly more likely to have mental comorbidity (50.3% vs 35.3%; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001).\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EAccording to Razaz, children with an MS parent showed no significant differences in any of the 5 EDI domains when compared with the control children. However, there was a relationship between the duration of a child\u0027s exposure to parental MS and vulnerability on the physical health and well-being domain of the EDI (adjusted OR, 1.49; 95% CI, 1.03 to 2.15). Parents with MS and a mental health comorbidity were more likely to have children vulnerable on the social competence domain (adjusted OR, 5.06; 95% CI, 1.02 to 25.1) and emotional maturity domain (adjusted OR, 3.0; 95% CI, 1.04 to 8.67). Razaz also noted that although the study was limited by its small size and a lack of access to information about the course of the parental MS, health professionals should be aware that a parent with MS and mental comorbidity might have an effect on childhood development over time.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/29\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp7se\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp7se\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp7se\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}