Association of tobacco use with seizures, psychosocial comorbidities, and quality of life among people with epilepsy: A cross-sectional analysis.

BACKGROUND: People with epilepsy (PWE) have elevated comorbidities of depression and cognitive deficits that are associated with substance use. The purpose of this study was to assess the association of: 1) tobacco use with seizure frequency, psychosocial comorbidities (depression/cognitive function), and quality of life; and 2) association between types of substance use and seizure frequency. METHODS: PWE (n = 143) were enrolled in two CDC-funded RCTs in 10 neurology and non-profit epilepsy clinics in Texas and Arizona August 2023 through March 2024. Validated scales assessed baseline tobacco use, seizure frequency, depression, cognitive function, and QOL. Cross-sectional analyses were conducted using robust modified Poisson regressions. RESULTS: Fifty five participants (38.0%) reported using a tobacco product and four reported using medicinal cannabis (2.8%). Cigarette use (36.3%) and multiple tobacco product use (29.0%) were most frequent. Tobacco-cannabis co-use was associated with having almost double the seizure frequency (aRR:1.8, 95% CI:1.2 - 2.6, p = 0.004) of non-use. Use of e-cigarettes was associated with almost double the seizure frequency of never-use (1.9, 95% CI: 1.1 - 3.2, p = 0.02). Multiple tobacco product use was associated with almost double the seizure frequency (1.8, 95% CI: 1.1-2.8, p = 0.01) of non-use. CONCLUSIONS: Tobacco use was significantly associated with medicinal cannabis which in turn was associated with increased seizure frequency among PWE. Given the risks associated with using multiple substances, more research is needed to better understand the association between epilepsy and multiple product use. These results underscore the need for integrating cessation-related resources into epilepsy clinics and self-management programs.