The effect of tobacco use/exposure on seizure frequency in adolescents with epilepsy

ABSTRACT Introduction and Aim: Epilepsy is one of the most common neurological disorders in childhood and adolescence. In recent years, the prevalence of smoking among adolescents has been increasing, as observed across all age groups. Smoking is believed to reduce adherence to antiepileptic medications and increase seizure frequency in patients with epilepsy. The aim of our study was to determine the smoking habits and exposure to smoking among adolescents diagnosed with epilepsy and investigate its effects on seizure frequency. Materials and Methods: Patients aged 12 to 18 years who were diagnosed with epilepsy and presented to the Pediatric Neurology Outpatient Clinic of Ankara Bilkent City Hospital between January 1, 2024, and October 31, 2024, were included in the study. Demographic characteristics of the patients, such as age, gender, age at epilepsy diagnosis, seizure frequency, seizure type, epilepsy type, and the antiepileptic drugs used, were recorded from their medical files. During face-to-face interviews, patients were asked questions about smoking habits, including smoking duration and amount, as well as knowledge of smoking-related harms. Parents were questioned about their age, educational status, smoking habits, and maternal smoking or exposure during pregnancy. Results: The average age of the patients was 187.01±19.1 months, while the mean age of diagnosis was 132.68±40.8 months, and 56.2% of the patients were female. Among the patients, 4% experienced seizures daily, while 54% had seizures less than once a month, and 69.2% were using a single antiepileptic medication. A total of 146 patients, corresponding to 29.2%, had tried smoking at least once, and 60 patients, representing 12%, were active smokers, with one patient using electronic cigarettes. On average, these patients had been smoking for 15 months and consumed 11 cigarettes per day. When the exposure to passive smoking in the household was examined, it was found that 255 patients, accounting for 51%, lived with at least one smoker at home. Among these, 191 patients lived with one smoker, 58 lived with two smokers, and 6 lived with three smokers. The average age of mothers was 42.17±5.08 years, while fathers' average age was 45.4±5.6 years. Most parents had an educational background at the primary or high school level. Of the mothers, 64 reported smoking before pregnancy, 30 quit during pregnancy, but 34 continued smoking during pregnancy, with an average of 6.64 cigarettes per day. Among the fathers, 224 smoked before pregnancy, and all continued smoking during the pregnancy period. Additionally, 14 mothers reported exposure to cigarette smoke from individuals other than the father during pregnancy. Conclusion: Despite all preventive measures and efforts, smoking continues to be a significant health issue in all age groups, including children. In children diagnosed with epilepsy, smoking and exposure to cigarette smoke not only cause various systemic health problems but also increase seizure frequency and reduce treatment success.