COCAINE-ASSOCIATED DYSTONIC REACTION

Dystonic reactions are extrapyramidal motor dysfunctions that result f rom an insufficient activity of nigrostriatal dopamine and present cli nically as spasms of the various muscle groups. Neuroleptic drugs are a known cause of dystonia and are the most frequently encountered trig ger. Cocaine use has been associated with dystonias, though much less often, When reported in the setting of a dystonic reaction, cocaine ha s been described as a predisposing factor for the patient already usin g neuroleptic agents. Fewer reports of dystonia as a direct result of cocaine use, independent of neuroleptics, are found in the literature, The cases of two acute dystonic reactions secondary to cocaine use ar e presented, with a discussion of the pathophysiology and treatment al ternatives. (Am J Emerg Med 1997;15:513-516. Copyright (C) 1997 by W.B . Saunders Company).