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Neurologic manifestations of cocaine exposure in childhood
S H Mott1, R J Packer, S J Soldin
1Neurology Dept, Children's National Medical Center, Washington, DC 20010.
Insights
Cocaine exposure in children frequently causes neurologic issues like seizures and obtundation, particularly in those under 8. Older children exhibit adult-like symptoms, highlighting the need for urine toxicology screening in unexplained seizures.
Area of Science:
- Pediatric Neurology
- Toxicology
- Emergency Medicine
Background:
- Neurologic effects of cocaine are well-documented in adults and neonates.
- Limited data exists on the specific neurologic manifestations of cocaine exposure in children and adolescents.
- Understanding these effects is crucial for accurate diagnosis and management in pediatric emergency settings.
Purpose of the Study:
- To delineate the spectrum of neurologic manifestations resulting from cocaine exposure in pediatric populations.
- To identify age-related patterns in cocaine-induced neurologic symptoms in children and adolescents.
- To provide evidence-based recommendations for the diagnostic workup of suspected cocaine exposure in young patients.
Main Methods:
- A prospective study involving 41 children (2 months to 18 years) presenting with suspected cocaine exposure.
- Clinical examination in an emergency department setting.
- Confirmation of cocaine exposure via urine gas chromatographic/mass spectrometric analysis.
Main Results:
- Nearly half (46%) of the children exhibited neurologic abnormalities, including seizures, obtundation, and delirium.
- Distinct age-related patterns were observed: seizures and obtundation in children under 5, and delirium/lethargy in older children.
- Passive inhalation was identified as a common exposure route in younger children; trauma was noted in adolescents.
Conclusions:
- Cocaine exposure is a significant concern in urban pediatric populations, frequently leading to diverse neurologic symptoms.
- Age-specific presentations, such as seizures in younger children and adult-like symptoms in older ones, are characteristic.
- Urine toxicology screening is recommended for all unexplained first-time seizures, including febrile seizures, in children.
Objective:
To describe the neurologic manifestations of cocaine exposure in children and adolescents as the neurologic effects of cocaine have been described in adults and neonates.
Methods:
During 1-year period, 41 children between the ages of 2 months and 18 years who had been exposed to cocaine, were examined in the emergency department at the Children's National Medical Center. Cocaine exposure was documented on urine samples; all were confirmed by urine gas chromatographic/mass spectrometric analysis.
Results:
Nineteen (46%) of 41 had neurologic abnormalities, including seizures (7), obtundation (6), delirium (4), dizziness (1), drooling (1), and ataxia (1). In 14 others, the neurologic effects of cocaine were difficult to determine because of other concomitant medical conditions, including head injuries and severe abdominal or chest trauma. Two major age-related patterns were seen: (a) in each child < 5 years of age, seizures and obtundation; and (b) in 11 older children, delirium (3), dizziness (1), drooling (2), and lethargy (4). Seizures, occurring at ages 12 months to 8 years, were focal with secondary generalization in three and generalized in four. They were associated with fever in two children. Six children had no further seizures, and one developed a mixed-seizure disorder. Passive intoxication while being in a room in which "crack" was smoked was the most likely cause of exposure for young victims. Multiple drug abuse was not documented in any child with neurologic impairment.
Conclusions:
1) Cocaine exposure is common in children in our urban setting; 2) neurologic manifestations frequently occur; 3) in children 8 years of age or younger, "passive" ingestion/inhalation is associated with focal and generalized seizures without evidence of structural brain injury; 4) cocaine may lower seizure threshold in children predisposed to seizures; 5) in children > 8 years of age, manifestations are similar to those in adults; 6) trauma and motor vehicle accidents were seen in the adolescent age group exposed to cocaine; and 7) urine toxicological study in cocaine exposure is recommended in all first-time seizures as well as first-time febrile seizures.