ReviewTobacco smoking, epilepsy, and seizures

- Tobacco smoke differs from nicotine.
- Many chemicals in tobacco smoke and many tobacco smoking cessation agents can induce, potentiate, or protect against seizures/epilepsy.
- Children exposed either in the intrauterine period or postnatally to secondhand tobacco smoke have a higher risk of seizures or developing epilepsy.
- It is unknown what role tobacco smoking plays in SUDEP and whether pregnant women who smoke or electronic cigarette smokers have an increased risk of seizures.

Tobacco smoking is considered the greatest risk factor for death caused by noncommunicable diseases. In contrast to extensive research on the association between tobacco smoking and diseases such as heart attack, stroke, and cancers, studies on the association between tobacco smoking and seizures or epilepsy are insufficient. The exact roles tobacco smoking and nicotine use play in seizures or epilepsy have not been well reviewed.We reviewed available literature and found that 1) there are vast differences between tobacco smoke and nicotine based on their components and their effects on seizures or epilepsy; 2) the seizure risk in acute active tobacco smokers, women who smoke during pregnancy, electronic cigarette smokers, and the role of smoking in sudden unexplained/unexpected death in epilepsy remain unclear; 3) seizure risks are higher in acute secondhand smokers, chronic active smokers, and babies whose mothers smoke; 4) tobacco smoke protects against seizures in animal models whereas nicotine exerts mixed effects in animals; and 5) tobacco smoking agents can be noneffective, proconvulsant, or anticonvulsant. Finally, the opportunities for future research on this topic is discussed.