title: The secret "spice": an undetectable toxic cause of seizure.
abstract: Neurologists and emergency department physicians are frequently involved in the comprehensive evaluation of a first generalized seizure. An important aspect of this evaluation is a detailed history which can identify a provoked seizure secondary to drug toxicity and hence avoid unnecessary treatment with antiepileptic drugs. "Spice" is an umbrella term for a variety of synthetic cannabinoid products whose inhalation has been associated with an increasing number of toxic side effects resulting in emergency department visits. These side effects (including psychosis, tachyarrhythmia, and seizures) are not typically seen with marijuana (Cannabis sativa) use. We report 2 patients with no prior history of neurological disease that experienced their first generalized tonic-clonic seizure after smoking Spice. The mechanism behind the possible proconvulsant effect of synthetic cannabinoids is not known, but it may be due to their effects at the cannabinoid receptor CB1. Although the US Drug Enforcement Administration placed 5 synthetic cannabinoids into schedule 1 for a 12-month period beginning March 2011, new Spice products containing different synthetic cannabinoids continue to emerge. Because synthetic cannabinoids are not detectable on commercial drug screens it is important that neurologists and emergency department physicians consider Spice inhalation in their differential diagnosis of a first generalized seizure.
authors: Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors: Adam
authors: A
authors: de Havenon
authors: Brian
authors: B
authors: Chin
authors: Karen C
authors: KC
authors: Thomas
authors: Pegah
authors: P
authors: Afra
keywords: Spice; cannabis toxicity; first generalized seizure; marijuana toxicity; provoked seizure; synthetic cannabinoid; toxic seizure
references: Toxicol Lett. 2010 Sep 1;197(3):157-62
references: 20566335
references: Rev Neurol Dis. 2007 Spring;4(2):103-6
references: 17609644
references: Drug Test Anal. 2011 Jul-Aug;3(7-8):466-78
references: 21337724
references: Forensic Sci Int. 2009 Oct 30;191(1-3):58-63
references: 19589652
references: Neuroscience. 2001;106(1):1-4
references: 11564411
references: Biochem Pharmacol. 2004 Nov 1;68(9):1691-8
references: 15450934
references: Eur J Pharmacol. 2001 Sep 28;428(1):51-7
references: 11779037
references: Epilepsia. 2009 May;50(5):1102-8
references: 19374657
references: J Pharmacol Exp Ther. 2010 Feb;332(2):569-77
references: 19906779
references: Epilepsia. 2008;49 Suppl 1:8-12
references: 18184148
references: Best Pract Res Clin Endocrinol Metab. 2009 Feb;23(1):1-15
references: 19285257
references: Epilepsia. 2001 Apr;42(4):464-75
references: 11440341
references: J Mass Spectrom. 2011 Feb;46(2):163-71
references: 21259394