A prospective study of smoking, caffeine, and alcohol as risk factors for seizures or epilepsy in young adult women: data from the Nurses' Health Study II.
OBJECTIVE
Seizures and epilepsy are associated with significant disability and substantial treatment costs, yet little is known about primary prevention. We prospectively examined the association of cigarette smoking, caffeine use, and alcohol intake with risk of seizure or epilepsy among women, aged 25-42 years, in the Nurses' Health Study II.


METHODS
Participants provided dietary and cigarette smoking information on multiple questionnaires beginning in 1989. Among 116,363 women at-risk for incident seizure or epilepsy, we confirmed 95 cases of seizure and 151 cases of epilepsy occurring from 1989-2005 using information from a detailed supplementary questionnaire and medical records. Multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.


RESULTS
Compared with never smoking, current cigarette smoking was associated with an increased risk of seizure (RR 2.60, 95% CI 1.53-4.42), after adjustment for stroke and other potential confounding factors. Past smoking was not associated with risk of seizure, but was associated with modestly increased risk of epilepsy (RR 1.46, 95% CI 1.01-2.12). Long-term caffeine and moderate alcohol intake were not associated with seizure or epilepsy.


CONCLUSIONS
Cigarette smoking may be associated with increased risk of seizure. More prospective studies are needed to investigate potential factors to ultimately prevent the development of seizures or epilepsy.
Dworetzky
Barbara A
BA
Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. bdworetzky@partners.org
Bromfield
Edward B
EB
Townsend
Mary K
MK
Kang
Jae H
JH
D000328:Adult; D017677:Age Distribution; D000428:Alcohol Drinking / Q000009:adverse effects*; D002110:Caffeine / Q000009:adverse effects*; D004827:Epilepsy / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008499:Medical Records / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000379:methods; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology* / Q000517:prevention & control; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires
D002110:Caffeine
Epilepsia. 2001 Oct;42(10):1261-5
11737160
Epilepsia. 1995 Apr;36(4):334-41
7541745
Epilepsia. 1993 Jul-Aug;34(4):592-6
8330566
CNS Drugs. 2003;17(14):1013-30
14594442
Neurology. 1989 Feb;39(2 Pt 1):267-71
2915800
Epilepsy Res. 1990 Aug;6(3):171-9
2272340
Mayo Clin Proc. 1996 Jun;71(6):576-86
8642887
Am J Epidemiol. 2009 Feb 1;169(3):313-22
19064645
Clin Chim Acta. 1996 Mar 15;246(1-2):59-76
8814971
Mol Pharmacol. 2002 Mar;61(3):695-705
11854451
Epilepsia. 1993 May-Jun;34(3):453-68
8504780
Seizure. 2004 Jun;13(4):284-5
15121141
Ann Intern Med. 2004 Aug 17;141(4):329-32
15313762
N Engl J Med. 1988 Sep 15;319(11):666-73
3412384
Paediatr Perinat Epidemiol. 1998 Jul;12 Suppl 1:76-95
9690275
Am J Obstet Gynecol. 1994 Jul;171(1):171-7
8030695
Ann Neurol. 1990 Feb;27(2):127-31
2317009
Epilepsia. 2002 Nov;43(11):1402-9
12423392
Epilepsy Behav. 2004 Jun;5(3):358-66
15145306
Am J Epidemiol. 1991 Apr 15;133(8):810-7
2021148
JAMA. 1988 Feb 19;259(7):1025-9
3339799
Epilepsia. 1991 Jul-Aug;32(4):429-45
1868801
Epilepsia. 1990 May-Jun;31(3):318-23
2344849
Pediatrics. 2005 Nov;116(5):1089-94
16263994
Pharmacol Biochem Behav. 1986 Jun;24(6):1509-11
2874565
Int J Epidemiol. 1989 Dec;18(4):858-67
2621022
Naunyn Schmiedebergs Arch Pharmacol. 1997 Jul;356(1):48-55
9228189
Can J Neurol Sci. 1999 Nov;26(4):263-70
10563210
Alcohol. 1988 Jan-Feb;5(1):55-61
3355671
Am J Epidemiol. 1990 Sep;132(3):462-73; discussion 474-8
2389751
Epilepsia. 1999 Apr;40(4):502-6
10219279
Epilepsia. 1976 Dec;17(4):387-93
1001283
Epilepsia. 1981 Feb;22(1):85-94
7472302
Pediatrics. 1997 May;99(5):E4
9113961