The Food and Drug Administration just issued a special announcement about a new health risk that they worry may be linked to e-cigarettes: seizures.
Since June 2018, the agency received what it called "a recent uptick" in reports where users describe having seizures that may be connected with their e-cigarette use. The FDA collects information about vape safety risks through their Safety Reporting Portal, where people who use e-cigarettes can share their experiences. Between reports via that portal and from poison control centers, the FDA counted 35 reports of seizures between 2010 and early 2019 that may be related to vaping. Most of those, it said, involved "youth or young adult users."
We know that nicotine poisoning can cause seizures, like when people swallow vape juice. But the FDA doesn't know yet what the relationship between seizures and vaping is here, says FDA Commissioner Scott Gottlieb in a statement today. Some of these seizures might be unconnected, or some might be caused by inhaling massive amounts nicotine. That seems less plausible, says Peter Chai, a medical toxicologist at Brigham and Women's Hospital in Boston. "I think exposure (skin contact or oral) in children, or vaping exposure in younger individuals (adolescents through which we've seen a large increase in e-cig use), might be accounting or the increase in these seizures," he says in an email to The Verge.
"To get enough nicotine in your body to cause seizures by smoking cigarettes is well-nigh impossible," says medical toxicologist Edward W. Boyer, an associate professor of emergency medicine at Brigham and Women's Hospital. But similar cases of nicotine-related seizures have been linked to eating it. Boyer thinks it's plausible that e-cigarettes could deliver enough nicotine to do the same. The truth is, there's not much data to go on. And for now, the FDA's Gottlieb says, "We can't yet say for certain that e-cigarettes are causing these seizures."
There are also lots of different types of seizures which, the FDA says, "result from sudden, abnormal electrical activity in the brain." This can lead to convulsions, but also can make people freeze and stare. They don't usually cause long-term damage - but public health experts would still like to figure out why and, if they find that the seizures are related to vaping, how to prevent them.
So far, there don't seem to be clear trends in the reports. The FDA said that there were people who reported a seizure after vaping for the first time, and people who experienced seizures after vaping for a while. Some people had been diagnosed with seizures before, and others suggested that they'd been using other substances, too, like cannabis or amphetamines. Making the agency's job even more difficult, most didn't say the brand of vape or vape juice involved.
The FDA suspects that the case count of 35 is an underestimate, given that people submit these reports voluntarily. But Chai expects that now that this potential link is out there, the FDA will get even more reports. The agency's asked the health care community to be on the lookout for potential vape-related seizures. And it wants e-cigarette users to tell their doctors if they experience any symptoms of seizures, which the CDC says can range from shaking to confusion. The agency also asks that people report health and safety issues with vapes to their Safety Reporting Portal, and list details including the manufacturer and brand of e-cigarette that they're using, as well as where they bought it.
The FDA's soon-to-be-ex commissioner Scott Gottlieb said in a statement today: "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."
