“Herbal seizures” – atypical symptoms after ibogaine intoxication: a case report

We report the case of a 22-year-old white man in good physical health (body height
of 184 cm; body weight of 76.6 kg) who used ibogaine for the first time; he had no
history of acute or chronic illness and no history of any drug dependence. He had
no concomitant use of prescribed medications. Prior to admittance he had not taken
any somatic medication for approximately 6 months.

According to his own statement, he wanted to achieve a “spiritual cleansing and reboot”
by taking ibogaine. He had ordered dried ibogaine root bark via the Internet and took
a cumulative dose of 38 g. He took two portions with 5 minute of latency between
the two doses, grinding it and dissolving it in water. He reported having visions
that occurred approximately 1 hour after he consumed the substance, which is a typical
finding in ibogaine use 10], 11]. These visions, which mainly consisted of visual memories of his life, lasted for
10 minutes. Subsequently, he felt nauseated and had to vomit repeatedly. Over the
next 30 minutes, the vomiting continued and he started to develop muscle tension and
cramps in his arms and legs. Ten hours after he took the drug, his relatives found
him having a generalized (tonic–clonic) seizure (please see also Fig. 1). The emergency physician administered midazolam intravenously. The patient was immediately
admitted to our intensive care unit, where he had several grand mal seizures. Within
the next 3 days, repeated administrations of midazolam were necessary to stop the
persistent generalized seizures. Anticonvulsive treatment with levetiracetam (1000
mg) was initiated on day two and immediately stopped the symptoms He was constantly
awake and had no further neurologic progression (for example tremor, clonus or hyperreflexia).
Cranial computed tomography and magnetic resonance tomography did not show any pathological
findings. All laboratory tests showed unspecific alterations which might be related
to the multiple previous epileptic seizures. In addition, slightly increased C-reactive
protein (CRP) values and white blood cell counts (including lymphocyte count and neutrophil
count), mild decreased platelet counts and elevated creatine-kinase values were found
temporarily during the first days after admission. No signs of an infection and no
inflammatory process were found.

Fig. 1. Electroencephalogram at day four after ibogaine intoxication. The electroencephalogram
shows an irregular alpha rhythm and a significant portion of diffuse theta waves consistent
with recent intoxication. No focal slowing and no epileptiform discharges are shown

His neurological status on day two revealed mild dysarthria with a subjective feeling
of heaviness of the tongue, mild bilateral ptosis and psychomotor slowness. An electroencephalogram
(EEG) showed mild diffuse encephalopathic changes but no epileptiform activity. On
day five, all symptoms had disappeared completely and the laboratory values had normalized.
Only the already declining creatine-kinase remained slightly increased, which was
consistent with his several previous tonic–clonic epileptic seizures. He was finally
discharged from our hospital. During a 3-month control period after this event that
included documented abstinence, he had no further seizures without levetiracetam treatment,
which had been tapered off after a few weeks. Detailed information about clinical
and laboratory findings is provided in Table 1.

Table 1. Apparatus and laboratory findings during the observation period after ibogaine intoxication