FDA: Risk of Seizure May Be Linked to E-Cigarette Use

Seizure may be an adverse effect of e-cigarette use, according to officials with the FDA.¹

In a joint announcement today, FDA Commissioner Scott Gottlieb, MD, and the agency's Principal Deputy Commissioner Amy Abernethy, MD, PhD said there is no confirmation of a direct link between the use of e-cigarettes—“vaping”—and a risk of seizure. However, reports indicate that some individuals, especially youth and young adults, are experiencing seizures or convulsions following use of e-cigarettes.¹

“We can’t yet say for certain that e-cigarettes are causing these seizures. We’re sharing this early information with the public because as a public health agency, it’s our job to communicate about potential safety concerns associated with the products we regulate that are under scientific investigation by the agency,” Gottlieb and Abernathy explained in a prepared statement. ¹

According to the FDA, seizures are known potential adverse effects of nicotine poisoning and have been reported in scientific literature in relation to intentional or accidental swallowing of nicotine-containing e-liquids.¹

Most e-cigarettes contain nicotine and can contain other harmful substances. Nicotine is highly addictive, according to the CDC, and can harm adolescent brain development, continuing into ages through mid-20 years.²

In an FDA review of voluntary adverse event reports for e-cigarette products submitted to the agency and to poison control centers, 35 cases of seizures following use of e-cigarettes between 2010 and early 2019 were identified. These included first-time users, as well as experienced users. ¹

“While 35 cases may not seem like much compared to the total number of people using e-cigarettes, we are nonetheless concerned by these reported cases. We also recognize that not all of the cases may be reported,” said the agency’s statement. ¹ “We believe these 35 cases warrant scientific investigation into whether there is in fact a connection.”

The reported cases included a few individuals with a prior history of seizure diagnosis, as well as a few instances that also included use of other substances, such as marijuana and amphetamines, according to the FDA. ¹

In announcing a possible link between seizure and e-cigarette use, the FDA indicated there may be additional cases that have not been reported. Agency officials are encouraging health care professionals and consumers to report any incidents of seizure following use of e-cigarettes, past or future, to the FDA. ¹

The agency has not identified specific e-cigarette products or brands that could be responsible for risk of seizure, due to lack of data and no establishment of a clear pattern. ¹

In addition to the potential risk of seizure, young people who use e-cigarettes may be more likely to smoke cigarettes in the future.² Youth and young adults are not often using e-cigarettes as a smoking cessation tool, as these products have been marketed, but rather as a substitute for traditional cigarettes that is viewed as less harmful.³

“Preventing tobacco use among youth is very critical to ending the tobacco epidemic in the United States,” said Laura Searcy MN, APRN, PPCNP-BC, FAANP, Chair of the Board, Cobb Community Alliance to Prevent Substance Abuse, in a presentation at last month’s national conference of the National Association of Pediatric Nurse Practitioners in New Orleans.³

According to Searcy, 9 out of 10 people who smoke began smoking before the age of 18 years, and 99% of American smokers started smoking before the age of 26 years.³

“We have done a great job in reducing smoking, combustible cigarette smoking. We had 2 decades of steady decreases. This year, for the first time, the rate of cigarette use went up, and a lot of that has to do with vaping,” Searcy said.³

“We are now losing ground,” she said.³

References

• Statement from FDA Commissioner Scott Gottlieb, M.D., and Principal Deputy Commissioner Amy Abernethy, M.D., Ph.D., on FDA’s ongoing scientific investigation of potential safety issue related to seizures reported following e-cigarette use, particularly in youth and young adults [news release]. Silver Spring, MD; April 3, 2019: FDA website. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm635157.htm. Accessed April 3, 2019.
• Centers of Disease Control and Prevention. Smoking & Tobacco Use: Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults. CDC website. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html. Updated March 11, 2019. Accessed April 3, 2019.
• Searcy L. Vaping in School: Addressing the Nicotine Use Epidemic Among Middle and High School Youth. Presented at: 40^th Annual National Conference of the National Association of Pediatric Nurse Practitioners, New Orleans. March 9, 2019.