Prevalence of Smoking in Patients with Seizures: Epilepsy vs. Psychogenic Nonepileptic Seizures

Objective: Smoking is the second most significant cause of early death and disability worldwide. Considering existing clinical and psychological differences between patients with epilepsy and psychogenic nonepileptic seizures (PNES), it was assumed that these 2 groups of patients vary in their rates of smoking. This retrospective study was based on an electronic dataset of patients with seizures.

Methods: All patients aged 20 years or older were surveyed at the outpatient epilepsy clinic of Shiraz University of Medical Sciences in Shiraz, Iran, between 2008 and 2020. Age at seizure onset, sex, and the final diagnosis were entered into the database for all patients. Other collected data included tobacco smoking (including cigarette and water-pipe as the 2 common forms of smoking).

Results: A total of 1491 patients were examined. In total, 226 patients (15.2%) reported smoking. Smoking rates were 13.3% in patients with idiopathic generalized epilepsy, 14.3% in those with focal epilepsy, and 21.3% in individuals with PNES (P = .01); a diagnosis of PNES was significantly linked to smoking. Female sex, younger age at the seizure onset, and having a college education were significantly inversely associated with smoking.

Conclusion: The high prevalence rate of smoking among patients with functional seizures is notable. It would be helpful to do a qualitative study on patients with functional seizures to understand why they are smoking. This can help us to understand the actual reasons behind the high prevalence rate of smoking in this population.

Cite this article as: Pooya AAA, Farazdaghi M, Damabi NM, Pooya AA, Akbari N, Rezaei A. Prevalence of smoking in patients with seizures: epilepsy vs. psychogenic nonepileptic seizures. Neuropsychiatr Invest. 2026, 64, 0072, doi: 10.5152/ NI.2026.25072.