Abstracts

Rationale: Previous research has demonstrated a positive correlation between epilepsy and smoking status. Subsequent studies have shown that patients with epilepsy who smoke have an increased likelihood of experiencing seizures within the past year. Despite these observations, the comprehensive role of smoking in the clinical presentation of epilepsy remains unclear. This retrospective study aims to investigate the predictive value of smoking status in relation to health outcomes in patients with epilepsy. The goal is to provide practitioners with insights that could enhance the personalization of care regimens for this patient population.


Methods: This retrospective analysis included 200 patients with epilepsy (101 non-smokers, 99 smokers) from Hawaii Pacific Neuroscience in Honolulu, Hawaii between November 2023 and April 2024. Descriptive statistics, chi-square tests, independent t-tests, and Wilcoxon rank sum tests were performed.

Results: Smokers with epilepsy had higher rates of hypertension (p=0.021) and dyslipidemia (p=0.007) compared to nonsmokers. The number of neurological comorbidities in smokers was higher than the non-smoking group (p=0.036). Substance use was also more prevalent among smokers, with higher rates of marijuana use (p< 0.001) and excessive alcohol consumption. Conversely, nonsmokers had higher rates of unspecified substance use and were more likely to have positive depression screening or PHQ9 scores, although this difference was marginally significant (p=0.052). Smokers were more frequently taking anti-epileptic drugs such as calcium current inhibitors (p=0.039), GABA antagonists (p< 0.001), and SV2A receptor blockers (p=0.045).

Conclusions: This study to our knowledge is the largest of its kind performed in the United States, and contributes to the expanding body of evidence examining the relationship between epilepsy and smoking.The increased prevalence of neurological comorbidities in smokers suggests that smoking may exacerbate the neurological burden in patients with epilepsy, potentially complicating overall management and treatment. Smokers are more likely to have hypertension and dyslipidemia, consistent with the established cardiovascular risks associated with smoking. Additionally, smokers exhibit higher rates of marijuana use and excessive alcohol consumption, indicating a broader pattern of substance use behavior among patients with epilepsy that clinicians should consider in their management strategies. The correlation between smoking and the use of specific antiepileptic drugs, such as calcium current inhibitors, GABA antagonists, and SV2A receptor blockers, may reflect differences in treatment approaches or disease severity between smokers and nonsmokers. These findings highlight the necessity of incorporating smoking status into clinical decision-making and management, to provide more comprehensive care for patients with epilepsy.

Funding: No funding was received in support of this abstract.