Unexpected cocaine intoxication presenting as seizures in children

We report four cases of unexpected cocaine intoxication in children manifested by the sudden development of seizures. Each patient presented with seizure activity of unknown etiology. Toxicology screens were positive for cocaine and its metabolites. All four had normal head computed tomography scans and have not required long-term use of anticonvulsants. One infant developed a mild learning disability. Cocaine intoxication should be considered in the differential diagnosis of new onset seizure activity in children. Child protection agencies should be consulted in all cases due to a high probability of abuse or neglect.