Can Smoking Increase Your Risk of Seizures?
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Medically reviewed by Smita Patel, MD
Smoking is a known risk factor for many health conditions, including cancer, heart disease, and stroke. In addition to these risk factors, people with epilepsy have another reason to avoid or quit smoking—it is linked to increased frequency of seizures.
This article will discuss how smoking can affect people with epilepsy.
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Prevalence of Cigarette Use By Adults With Epilepsy
According to a report from the Centers for Disease Control and Prevention (CDC), from 2010 to 2017, 1 in 4 adults in the United States who are living with epilepsy smoked cigarettes. By comparison, 1 in 6 adults without epilepsy smoked.
Can Smoking Cause Seizures?
Studies have shown that current smokers with epilepsy were more likely to have experienced seizures in the past year than nonsmokers with epilepsy. One study found smokers were nearly 4 times more likely than their nonsmoking peers to have experienced a seizure in the previous year.
Data from a 2022 study suggest that people with epilepsy who have a higher seizure frequency are more likely to be current smokers, suggesting the correlation goes both ways. People who have epilepsy and who smoke have also been reported to have a higher risk of refractory epilepsy (epilepsy that does not respond well to medication).
Smoking may also affect the risk of seizures indirectly by causing poor sleep quality, which is a known seizure trigger.
In addition to an increased risk of seizures, smoking can be dangerous for people with epilepsy as having a seizure while smoking may cause burns or fire.
Smoking Cessation Drugs and Seizures
Smoking cessation medication can be helpful for people who wish to quit smoking, but not all of these medications are safe for people with epilepsy.
Bupropion, which has several brand names including Zyban and Wellbutrin, is a pill used to treat depression and also can be used for quitting smoking. It does not contain nicotine and is not a nicotine-replacement medication.
The CDC advises against taking bupropion if you have or have ever had a seizure disorder. Bupropion has an overall seizure risk of about 1 person in 1,000 at a dose up to 300 milligrams (mg) per day, including people who don't have epilepsy. The risk increases to 4 out of 1,000 people at a dose up to 400 mg per day.
Other smoking-cessation drugs may or may not be appropriate for you personally or for people with epilepsy generally. Talk to your healthcare provider or pharmacist before using any smoking cessation aids.
Cigarettes contain many chemicals and ingredients that may trigger seizures, including:
Nicotine
Ammonia
Lead
Hexane
Toluene
Cresol
Arsenic
Acetone
In addition to the potential for triggering seizures, nicotine has been shown to reduce the effectiveness of certain antiepileptic drugs.
The carbon monoxide in tobacco smoke is associated with increased levels of carboxyhemoglobin (CO-Hb) in the blood, which is a potential cause of seizures. The CO-Hb level in people who don't smoke is about 1% to 2%, while in people considered heavy smokers it is 5% to 6%, and can be as high as 10% in people with seizures.
Vaping and Epilepsy
The link between vaping (using electronic cigarette, or e-cigarette, products) and seizures is under review as vaping becomes a more prominent health issue for children and adolescents. Research suggests that vaping can trigger or increase the risk of seizures, even in people who do not have a history of seizures.
As of March 2021, more than 250 reports of seizures associated with e-cigarettes were reported to the Food and Drug Administration (FDA). About two-thirds of these cases involved youths or young adults.
E-cigarettes can contain as much nicotine as a full pack of cigarettes. With research showing that about 62% of reported seizures occur within half an hour of vaping, nicotine toxicity has been suggested as a potential cause for the seizures.
The high levels of nicotine also makes nicotine dependence more likely and to happen faster. Young people may also vape more frequently because e-cigarettes are easier to hide than cigarettes that burn down, leading to increased nicotine intake.
The FDA has released a statement warning of the potential safety issue of seizures associated with e-cigarettes, particularly in young people. The FDA has not determined an absolute causal link between vaping and seizures, but believes the available findings are enough to warrant further research and a warning to the public.
The FDA also suggests that these cases may be underreported and asks the public to notify the agency of seizures or any other adverse effects that may be connected to vaping.
Vaping is sometimes touted as a method to help quit smoking, but there are safer ways to do so, particularly for people with epilepsy.
Smoking Cannabis and Seizures
Anecdotal and preclinical research suggest cannabis-derived therapies may help people with epilepsy, but this subject is still highly under-researched. As cannabis becomes more accepted socially and legally, restrictions on research may be lifted to allow more studies to be conducted.
The neurotransmitters endocannabinoids are the brain's internal counterpart of the psychoactive chemicals in marijuana. They are believed to play a part in inhibiting excessive excitement in the brain.
While they have similarities, marijuana and endocannabinoids are not the same. Smoking marijuana floods the brain with the chemical tetrahydrocannabinol (THC), and the effects are relatively long-lasting. Endocannabinoids are released in precise locations and under more specific circumstances. They are also in place for an extremely short period.
The potential for creating a drug that works with these endocannabinoids to help control seizures is promising, but these findings do not mean smoking marijuana controls seizures.
While there is growing evidence in support of the use of cannabis to help control some forms of seizures, there isn't a consensus in the medical community on if and how it should be used.
Before cannabis became legalized in Canada, Health Canada, the Canadian government's agency for national health policy, allowed it to be used by prescription for treating some health conditions, including epilepsy, but the agency did not endorse its efficacy.
Cannabis does not need to be smoked; it comes in a number of different forms, including oils, capsules, and edibles.
If you think cannabis may benefit you, talk to your healthcare provider before using it to ensure it is safe. Ask if they have recommendations for products to try. as potency and effects can vary.
Vaping cannabis products is strongly advised against as the risks outweigh the benefits. It's also recommended that if you choose to try cannabis products, look for pharmaceutical-grade ones obtained according to the laws and regulations in your location.
Talking to Your Healthcare Provider About Quitting Smoking
Before quitting smoking, talk to your healthcare provider about safe ways to do so. Discuss your options with them, and ask about how they may affect your seizures or anti-seizure medication. Also ask about how withdrawal could affect you, and ways to manage it.
The CDC offers resources to help you quit smoking.
Other resources include a national portal to a network of state quitlines, affiliated with the CDC. It offers evidence-based support, counseling, referrals to local programs, free medication, and other resources to people who want to quit smoking.
It can be reached in the following ways:
English: 800-QUIT-NOW (800-784-8669)
Spanish: 855-DÉJELO-YA (855-335-3569)
Mandarin and Cantonese: 800-838-8917
Vietnamese: 800-778-8440
A free six- to eight-week program is offered by the National Cancer Institute’s Smokefree.gov. Participants receive daily supportive texts to help quit smoking: Text QUIT to 47848.
The quitSTARTapp is a free smartphone app that offers inspiration, challenges, and tailored tips.
Summary
Research suggests smoking can increase seizure frequency in people with epilepsy. This may be due to the effect of nicotine and other chemicals found in tobacco cigarettes.
While more research is needed, vaping is also believed to be a potential trigger for seizures, even in people without epilepsy.
Cannabis products are being studied as a potential treatment for certain types of seizures, but there is currently no medical consensus on their use. While current evidence is promising for the development of medications using cannabis, it does not conclude that smoking marijuana prevents seizures.
Smoking cessation medications may interfere with antiepileptic medications. Always talk to your healthcare provider before quitting smoking or using a smoking cessation aid.
Frequently Asked Questions
Does smoking make epilepsy worse?
There is evidence that smoking can increase seizure frequency, both directly from the chemicals in cigarettes and how they affect the brain, and indirectly by affecting your health in other ways that impact epilepsy, such as sleep disturbances.
Can secondhand smoke cause seizures?
Exposure to secondhand smoke, particularly when frequent, may increase the risk of seizures.
Does nicotine affect seizure medication?
Nicotine can reduce the anticonvulsant effects of some antiepileptic medications. It may also trigger seizures, especially in higher doses.
