This review aims to synthesize, quantify, and describe the published literature on how smoking, vaping, and nicotine affect people with epilepsy and seizures.

People with epilepsy may smoke at increased rates. Nicotine and other chemicals in tobacco smoke may lower the seizure threshold or affect seizure control through pharmacokinetic interactions with anti-seizure medications. Conversely, nicotine has been used as an anti-seizure medication in autosomal dominant sleep-related hypermotor epilepsy. There is little known about smoking cessation in people with epilepsy, but some anti-seizure medications have been studied for smoking cessation.

The Joanna Briggs Institute Manual and the PRISMA Extension for Scoping Reviews informed the design of this review. Our protocol was registered with the open science framework () and published previously ().

A total of 7761 records were screened and 229 were included for data extraction. Studies were published in a total of 38 countries. One hundred and forty original research articles, 43 abstracts, 23 reviews (14 narrative, 9 systematic), and 23 other publications were identified. Studies investigated: the prevalence of smoking in people with epilepsy (46), rates of smoking amongst subpopulations of people with epilepsy (20), the effect of smoking on seizure control (17), the effect of smoking on another health outcome in people with epilepsy (38), the effect of anti-seizure medications on smoking cessation (37), seizures provoked by nicotine (39), the use of nicotine as an anti-seizure medication (13), tobacco or nicotine use as a risk factor for developing epilepsy (20), the effect of smoking on pharmacokinetics of anti-seizure medications (23), and smoking cessation specifically in people with epilepsy (2).

Published literature demonstrates that smoking and nicotine affect people with epilepsy in myriad ways. The literature is heterogeneous, and conclusive evidence is lacking to answer many outstanding questions. This review identifies topics warranting further investigation.