Smoking and Seizures: Where the Evidence Stands

Andrew N. Wilner, MD


November 03, 2015

Tobacco Use and Risk for Seizure

Tobacco use predisposes to a multitude of ills including cancer, chronic obstructive pulmonary disease, myocardial infarction, and stroke and results in 6 million deaths per year.[1] The 2010 National Health Interview Survey of health behaviors revealed that people with epilepsy are just as likely to smoke, if not more so, compared with people without a history of epilepsy (21.8% vs 19.3%).[2]

It is not known whether cigarette smoking has any effect on the likelihood of seizure in people with epilepsy. However, the risk for seizures may be higher among chronic smokers, babies whose mothers smoke, and those exposed to second-hand smoke.[1]

Nicotine and 5000 Other Chemicals...

Nicotine is a parasympathetic alkaloid that binds to the nicotinic acetylcholine receptor. While nicotine is considered proconvulsant, there are case reports of seizure improvement in patients wearing a nicotine patch.[1] The fact that cigarette smoke contains at least 5000 other chemicals raises the possibility for multiple central nervous system and systemic effects, which may be proconvulsant or anticonvulsant.[1]

Cigarettes and SUDEP?

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with uncontrolled seizures.[3] The cause of SUDEP is unknown. Autonomic dysfunction, cardiac arrhythmias, and respiratory compromise are leading etiologies, all of which may be engendered by cigarette smoking, raising the possibility that smoking may contribute to SUDEP.[1,3] However, research on this topic is limited, and confirmatory data are lacking.