RELATION OF COCAINE USE TO SEIZURES AND EPILEPSY

Purpose: Cocaine can provoke seizures, exacerbate a preexisting seizur e disorder, or cause an ischemic or hemorrhagic stroke that leads to s eizures. To determine the importance of cocaine use in patients with a nd without epilepsy, we studied these relations and other risk factors for seizures and the mode of cocaine use. Methods: We reviewed all ch arts of emergency department visits and hospitalizations of patients w ith discharge diagnoses simultaneously listing seizures, epilepsy, and cocaine use during a 24-month period. Data collected included patient age, sex, route of cocaine use, seizure description and duration of e pilepsy, provocative factors, results of electroencephalography and co mputed tomography, treatment, and outcome. Results: Of 67,668 adult em ergency department visits and 25,768 adult admissions, 1,900 were coca ine related, and 58 of these also had seizures or epilepsy. Seizure oc currences were approximately equally distributed among groups with idi opathic epilepsy, remote symptomatic localization-related epilepsy, ce rebrovascular disease, and acute symptomatic seizures due to cocaine u se alone. Less frequently, seizures were cryptogenic or symptomatic of metabolic abnormalities. Conclusions: Cocaine use can reduce seizure threshold in patients with underlying epilepsy as a direct toxic effec t or indirectly by contributing to poor compliance with antiepileptic drug treatment, poor diet, or poor sleep habits. In 12 of the 58 patie nts, cocaine appeared to be the only provocative factor. This may be a less significant risk factor for epilepsy than either alcohol or head trauma.