Abstracts

Rationale: Synthetic cannabinoids refer to a growing number of man-made hallucinogenic chemicals sprayed on dried, shredded plant material or vaporized to get high. Synthetic cannabinoids act on the same brain cell receptors as delta-9-tetrahydrocannabinol, the hallucinogenic ingredient in marijuana. The effects of synthetic cannabinoids can be unpredictable, severe, or even life threatening. In this retrospective case series, we review the epidemiology of synthetic cannabinoid associated seizures. Methods: This is a retrospective chart review of all patients 18 years and above with new onset seizures between 2014 and 2015 seen by neurology when there was spike in synthetic marijuana use among the local population. Patients included in this study had MRI brain with/without contrast (seizure protocol), routine EEG, complete blood count, metabolic panel, comprehensive urinary drug screen, urinary synthetic cannabinoid screen by ELISA; confirmed by liquid chromatography?"mass spectrometry (LC-MS). History of seizures was confirmed by clinical history/exam, and in some cases, EEG and other causes of seizures were ruled out by comprehensive imaging and lab studies. Results: 10 patients (7 males, 3 females) age range 19-32 years (median: 21 years), all Caucasians, were included as they met the study's inclusion criteria. Patients were admitted with a history of generalized tonic clinic seizures. All patients had a normal MRI brain. Complete blood count, comprehensive urinary drug screen and metabolic profiles were normal. Routine EEG showed generalized interictal spike-polyspike discharges in two patients who were eventually diagnosed with juvenile myoclonic epilepsy. Mean time between smoking synthetic cannabinoid and having seizure was 4 hours (2-48 hours, p < 0.05). In 4 patients seizures were triggered after first smoke (including those who were diagnosed with JME), 3 had 2 smokes, 2 of them had 4 smokes and one had multiple smokes. There has been no recurrence of seizures with more than a year of follow-up. Conclusions: Synthetic cannabinoids can be a trigger for seizures in both epileptic as well non epileptic patients with seizures occurring within 4 hours of smoking (but sometimes as long as 48 hours). There is no evidence of seizure recurrence although more long term studies are needed to clarify this. Funding: none