Sage tea related convulsions in a pediatric patient

In the United States and Europe, there is increasing popularity for complementary medicines, including various herbal preparations. Contrary to their purported safety, these agents may produce several serious side effects, notably on the central nervous system. Dalmatian sage (Salvia officinalis), as an essential oil or extract, is a popular home remedy for various ailments, but may pose health risks because they contain epileptogenic monoterpene ketones (which include camphor and thujone). We report a case of convulsions in a pediatric patient following ingestion of tea made from dalmation sage. A previously healthy 18 month-old female with 3 days of intermittent vomiting and diarrhea without fevers, was given a tea made from water and a home-grown herb. Two hours after drinking the tea, the child developed tonic-clonic contractions of the upper extremities, left eye deviation, and unresponsiveness that lasted less than 1 min. There was no prior history of convulsions. The child was evaluated in the ED, where she was afebrile with a normal physical exam, head CT, CBC, and serum chemistries. She was discharged home, but 18 hours after her initial ingestion, she developed three subsequent seizures requiring treatment with lorazepam. An EEG the following morning showed some parietal lobe slowing, interpreted as a possible seizure focus. A sample of the herb was identified by a botanist as S. officinalis or sage. Tea made from sage may have kindled convulsions in a child with a previously unmasked seizure focus.