A spicy status: Synthetic cannabinoid (spice) use and new-onset refractory status epilepticus—A case report and review of the literature

Abstract

Synthetic cannabinoids refer to a wide variety of chemicals engineered to bind cannabinoid receptors (CB1 and CB2) and mimic the effects of delta-9-tetrahydrocanabinol. The potential for severe toxicity and limited in vivo data make synthetic cannabinoid intake an important public health and safety concern. Neurologic toxidromes associated with their use include mental status changes, panic attacks, memory distortions, acute psychosis (e.g. paranoia, delusional thoughts), disorganized behavior, and suicidal and homicidal thoughts. Systemic complications include vomiting, sinus tachycardia, myocardial infarction, and acute kidney injury. Seizures are common; however, status epilepticus is not widely reported. In this case report, we describe a patient who developed acute psychosis and new-onset refractory status epilepticus necessitating emergent neurological life-support and prolonged admission to an intensive care unit following abuse of synthetic cannabinoids. We include a brief review of the literature to prepare the treating clinician for the broad clinical spectrum of this increasingly common intoxication.

In vitro determination of the CB1 efficacy of illicit synthetic cannabinoids

“…SCRA use has been associated with adverse health effects including hundreds of hospitalisations and dozens of fatalities (Cooper, 2016, Springer et al, 2016, Adams et al, 2017. The most commonly reported adverse effects are psychosis, anxiety, agitation, seizures, tachycardia, hypothermia, and kidney injury (Babi et al, 2017, Tait et al, 2016. In addition to these life-threatening effects, daily SCRA use has been linked to dependence and withdrawal (Macfarlane and Christie, 2015).…”

Man vs. man-made marijuana: A case of drug-induced posterior reversible encephalopathy syndrome (PRES) due to K2, a synthetic cannabinoid (SCB)

“…SCB are mostly smoked or inhaled while some use it as an additive to herbal teas or food [6]. The major engineered compound in SCB mimics the active constituent, delta-9-tetrahydrocanabinol (THC), of marijuana that binds to the G protein-coupled cannabinoid receptors (CB), cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2) [2,7,8]. SCB can contain multiple active ingredients and little is known about the metabolism of those compounds [8,9].…”

Febrile Infection-Related Epilepsy Syndrome: Refractory Status Epilepticus and Management Strategies

“…Cannabidiol (CBD) works by decreasing glutamate and gamma-aminobutyric acid synaptic transmission in the brain. The resultant decrease in excitatory neurotransmitter release may increase the seizure threshold [36]. In a recently published case series, CBD appeared effective in reducing the frequency and duration of seizures in patients with FIRES who had not responded to standard AEDs or other therapies [37].…”