Smoking contributes to the death of approximately 500,000 people each year from heart disease, stroke, and cancer. Smoking tobacco is not known to have any definite effects on seizure control. But persons with epilepsy are not only susceptible to all the usual effects of smoking, but also are at increased risk of injury or death from fire.

Consider what happened to an epilepsy patient and her daughter. The patient, a 35-year-old woman with absence and tonic-clonic seizures, shared an apartment with her lively 5-year-old daughter. One evening, the woman had a tonic-clonic seizure while smoking. When she awoke in the hospital, she had first-degree burns on a large part of her arms and body. Her daughter suffered severe smoke inhalation and brain damage. The girl, now 18 years old, is severely retarded, uses a wheelchair, and is in an institution. The woman stopped smoking and went through a long emotional process of dealing with what happened.

Unlike many other activities, smoking presents risks not only for the person with epilepsy, but also for others, who can be severely injured or killed. Therefore, any person with epilepsy who has episodes of impaired consciousness should stop smoking. There are a variety of programs and methods (acupuncture, for instance) that can help a smoker to stop smoking. The use of nicotine patches to help break the smoking habit is safe for people with epilepsy. The use of Zyban (buproprion) tablets as an aid to stop smoking can increase the seizure frequency or intensity, but at the usual dosage of 300 milligrams per day, the risk of worsening the seizures is small. If the seizures are well controlled and the blood levels of antiepileptic drugs are adequate, the benefits of Zyban are likely to outweigh the risks. For those who find it impossible or unacceptable to stop smoking, the risk of a dangerous fire can be substantially reduced by smoking only when another adult is nearby. Of course, all places where people smoke should be equipped with working smoke detectors.

Topic Editor: Steven C. Schachter, M.D.
Last Reviewed:12/15/06