Background: Strox is the street name of the novel synthetic cannabinoids widely abused in the last few years in Egypt causing many toxic effects including seizures. The aim of the work: The study evaluated the potential seizurogenic effect of strox toxicity and the possible use of microRNA (miR) expressions as predictive biomarkers for diagnosis and follow up. Methodology: A cross- sectional prospective observational study was carried out on 60 patients presented to ER of Zagazig University Hospitals following strox intake during the period from March 2018 to May 2020. Epidemiological data, route of consumption & frequency of drug abuse during the last 12 months were recorded. All patients were subjected to clinical examination, Electroencephalogram (EEG), measurement of serum miR-9-3p, miR-106b-5p and miR-15a-5P, and miR 30a-5P expressions using real time-polymerase chain reaction (qRT-PCR) at time of presentation, after 72hrs and 28 days of presentation. Results: The median age of patients included were 19-35, most of them were male (96.6%). Of the included cases, 46.6% presented with seizures which was mainly in the form of generalized tonic clonic convulsions (43%). EEG revealed abnormal changes in only 35% of patient who developed seizures at time of presentation and in 9% of those who developed seizures after 72 hours with no EEG changes were recorded after 28 days of follow up. Assessment of genes expressions revealed upregulation of miR-9-3P, miR-106b-5p and miR- 30 a-5P and downregulation of miR-15 a-5P at time of presentation in patients with seizures with both miR9-3P, and miR 30 a-5P persisted upregulated during follow up periods, while miR106b-5p and miR 15 a-5P returned to normal. Conclusion: miR9-3p and miR 30 a-5p can be used as predictive biomarkers in diagnosis and follow up of strox induced seizures. Keywords: Strox, microRNA. Seizures, EEG