Woman in cafe using e-cigarette

The introduction of e-cigarettes brought promise for good and bad. We hoped it would be the answer for smokers who really wanted to quit, offering a way to focus on tapering the nicotine addiction while reducing other substances, such as tar, that cause so many health issues. E-cigarettes also offer an outlet for the physical habits that accompany smoking.

But few studies have shown that e-cigarettes actually help people quit smoking. Some show they don’t reduce cigarette use, and a couple even suggest they increase cigarette use.

In addition, concerns over e-cigarette use among teens have been front of mind since their introduction. Vice reported way back in 2014 that there were 460 brands selling 7,700 flavors of e-cigarette juice with names like Atomic Cinnamon, Sour Apple, or Lava Flow. It sounds suspiciously like a new product targeting a young, untapped market rather than a smoking cessation product targeting established smokers.

Woman in cafe using e-cigarette

At the American Academy of Neurology meeting last week in Philadelphia, Frances E. Jensen, MD, author of The Teenage Brain and Chair of the Department of Neurology at the Perelman School of Medicine at the University of Pennsylvania, mentioned e-cigarettes in her talk on The Teenage Brain: Neuroscience You Can Use. She pointed out that because of their brains’ increased plasticity, teens get addicted faster than adults (they learn faster, too, but that comes at a price, apparently). Jensen mentioned that a single JUUL cartridge contains 55–60 mg of nicotine, comparable to an entire pack of cigarettes. Marketing, plus a higher susceptibility to addiction, plus greater amounts of an addictive substance seems like a bad formula for our teens.

Now you can add another tick mark in the “bad” column for vaping. The FDA published a statement in April 2019 that they will be investigating incidents of seizures after e-cigarette use.

The report revealed that 35 cases of seizures, mostly among teens and young adults, occurred after e-cigarette use between 2010 and 2019. While this number may seem small compared to the total number of e-cigarette users, the FDA is concerned by the cases.

There may be no direct link between the reported seizures and e-cigarettes, but the concern is that seizures are a known symptom of nicotine poisoning. If e-cigarettes allow inadvertent increased ingestion of nicotine (see JUUL nicotine content above) or if people are intentionally using the product to take in higher levels of nicotine, this is a relationship that needs to be examined.

The FDA is urging people to report negative effects after vaping to The Safety Reporting Portal. With more data, the agency hopes to be able to determine whether there is a link between e-cigarette use and seizures. If a link does exist, they hope to discover common risk factors, or characteristics of the e-cigarettes themselves, that contribute to the problem.

For the neurologist, or any physician caring for patients with seizures, e-cigarette use is taking on a more significant part of the patient history. It will be years before a clear relationship is defined, if one exists at all. But attention from physicians will help illuminate any relationship that does exist, providing better information to keep patients, especially adolescents, safe from the bad, even if it is disguised as good.

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