Publications & Reports

A systematic review of evidence on the association between cocaine use and seizures.

Sordo L, Indave BI, Degenhardt L, Barrio G, Kaye S, Ruíz-Pérez I, Bravo MJ
National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University, Madrid, Spain; Network Biomedical Research Centers, Epidemiology and Public Heal


BACKGROUND: Institutional monographs/medical textbooks mention seizures as a neurological complication of cocaine, but no systematic reviews (SRs) have been published on this issue. We aimed to conduct a SR of the literature on the relationship between cocaine use and seizures and to summarize the biological plausibility of that relationship. METHODS: The pathophysiological mechanisms that may underlie an association between cocaine and seizures were summarized; a SR was then performed using three databases (EMBASE, Medline, PsycINFO) and the Cochrane-library to search for published papers (1980-2012) aimed at quantifying the associations between cocaine use and seizures. The inclusion criteria for selection were: articles based on clinical trials, cohort, case-control (CC) or cross-sectional (CS) studies, participants >/= 14 years old and not pregnant, and use of cocaine in the last 72 h. Information was extracted, evaluated and cross-checked independently by two researchers. RESULTS: Of the 1243 potentially relevant articles initially identified; one CC and 22 CS studies were finally selected. The CC study did not find cocaine use to be a risk-factor for seizures. In addition to the limitations of the CS design, these studies had important methodological weaknesses and biases. CONCLUSIONS: Despite its biological plausibility, no rigorous scientific evidence supports a causal relationship between cocaine use and seizures. The misinterpretation of the role of cocaine may have important implications in medical services. Well-conducted studies are urgently needed.


  • Journal: Drug and Alcohol Dependence
  • Published: 15/12/2013
  • Volume: 133
  • Issue: 3
  • Pagination: 795-804

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