Status Epilepticus and Lateralized Periodic Discharges (LPDs) in Cannabis Withdrawal Syndrome: A Case Report and Review of the Literature

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Withdrawal syndrome is relatively common among chronic cannabis users. It generally manifests as psychiatric disorders and, in rare cases, as epileptic seizures. We report the case of a 53-year-old female patient who, following the abrupt cessation of her chronic and daily cannabis use, presented with a tonic-clonic status epilepticus. She was treated with midazolam and phenobarbital. The electroencephalogram (EEG) performed after the cessation of convulsive episodes and the persistence of a state of confusion revealed over a slowed background activity the presence of lateralized periodic discharges (LPDs). Brain imaging, biological workup, and cerebrospinal fluid study ruled out any other causes of secondary epileptic seizures. The patient was placed on benzodiazepine and carbamazepine. The course of the condition was marked by clinical improvement and the disappearance of the LPDs on the follow-up EEG. Our case highlights the possibility of serious neurological manifestations, such as status epilepticus, following abrupt cannabis withdrawal, associated with the presence of lateralized periodic discharges (LPDs) on the EEG. This association is linked to a high risk of recurrent epileptic seizures and therefore requires the initiation of anticonvulsant treatment.