Table 1.

Existing debates and controversies with e-cigarettes as a cause of seizures.

Controversy	Description
Etiology of symptoms	There is consensus on the adverse effects of high nicotine levels, but questions remain about how e-cigarettes deliver nicotine rapidly and whether this leads to toxic-level complications like seizures. It is hypothesized that increased plasma concentration and higher bioavailability of nicotine contribute to the exaggerated effects.
Timing of presentation	Varied times of seizure presentation have been reported, ranging from immediately after e-cigarette use to several hours later. The immediate post-use presentation is plausible due to peak nicotine levels, but the existence of delayed seizures challenges this hypothesis.
Quality of evidence	Scholars question why seizures are the only reported toxicity of e-cigarette use, as nicotine toxicity typically presents with systemic symptoms. Doubts persist regarding the reliability of reported seizures, with some cases suggesting misdiagnosis or unreported concurrent conditions. Normal investigations in some cases contradict nicotine toxicity, raising further doubts. Individual susceptibility may also play a role in seizure presentation, suggesting the need for investigation into usage patterns and medical conditions.