P3.B034: Marijuana-Induced Seizures in a 4-Month-Old: A Unique Presentation Requiring Child Protection Team Evaluation.

Introduction: Cannabis use is often studied in relation to unintentional pediatric ingestion and recreational adolescent consumption, but there is a dearth in the literature describing its neurological sequelae in infants. New-onset THC-induced seizures have been reported in children ages 1-3, but few describe its clinical presentation in infants.

Case Description: A 4-month-old male born term Spontaneous Vaginal Delivery with no perinatal complications presented to an Outside Hospital (OSH) emergency department (ED) for new-onset seizures. Family reported generalized extremity and head shaking with eye fluttering for 5 minutes at home, followed by somnolence. Associated symptoms included an intermittent cough, but family otherwise denied fevers, congestion, rhinorrhea, poor feeding, emesis, oliguria, diarrhea, or rashes. His vaccinations were up to date, he had no prior surgeries, or previous hospitalizations. Family history significant for maternal grandmother with seizures.

At the OSH ED, the patient had a 37.8˚C temperature and a seizure described as bilateral myoclonic jerking arm movements, head shaking, and eye fluttering with left gaze deviation lasting 5 minutes followed by postictal drowsiness. He was given a 20mg/kg Keppra loading dose and a normal saline bolus. Lab workup and head CT unremarkable. He was then transferred to our hospital for further evaluation. Patient arrived somnolent but arousable, with no focal deficits and a Glasgow Coma Scale (GCS) of 15. He received 1 dose of Rocephin after a complete sepsis workup was completed.

The hospital child protection team was consulted due to a positive urine drug screen for cannabis with concern for marijuana ingestion secondary to intentional supply by a caregiver known to be a cannabis user. It was concluded that the patient was a victim of neglect-threat of harm/lack of supervision and the Department of Human Services (DHS) was thus notified.

The patient was monitored inpatient for 24hrs. EEG results showed no recurrent seizure activity and MRI brain revealed no focal lesions. Neurology agreed seizures were likely incited by cannabis. The patient was discharged with a DHS safety plan and PCP follow-up.

Discussion: With this child’s non-ambulatory history and other symptoms clouding his clinical picture, marijuana ingestion was not initially high on his new-onset seizure differential. This case illustrates the importance of considering cannabis-induced seizures, even in infants. Seizures, decreased GCS scores, and lethargy are often the only neurological manifestations of cannabis intoxication from ages 0-3. Among 27 states, marijuana-related hospital visits in young children increased 13-fold from 2004 to 2018, with 15% requiring intensive care, demonstrating need for prevention.

Conclusion: Larger cannabis toxicity studies are warranted given increased access to the general population and wide variety of products and doses available. This case is unique because the patient presented with a common diagnosis of first-time seizures, but with an atypical presentation involving cannabis ingestion necessitating abuse evaluation.