benzoylecgonine and Seizures

The objective of this study was to determine the prevalence of positive plasma drug screening for cocaine or amphetamine in adult emergency department seizure patients.. This prospective study evaluated consecutive eligible seizure patients who had a plasma sample collected as part of their clinical evaluation. Plasma was tested for amphetamine and the cocaine metabolite benzoylecgonine using enzyme-mediated immunoassay methodology. Plasma samples with benzoylecgonine greater than 150 ng/mL or an amphetamine greater than 500 ng/mL were defined as positive. Patient demographics, history of underlying drug or alcohol-related seizure disorder, estimated time from seizure to sample collection, history or suspicion of cocaine or amphetamine abuse, results of clinical urine testing for drugs of abuse, and assay results were recorded without patient identifiers.. Fourteen of 248 (5.6%, 95% CI 2.7%-8.5%) plasma samples were positive by immunoassay testing for benzoylecgonine and no samples (0%, 95% CI 0-1.2%) were positive for amphetamine. Positive test results were more common in patient visits where there was a history or suspicion of cocaine or amphetamine abuse (p < 0.0005).. During this study period, routine plasma screening for cocaine and amphetamines in adult seizure patients had a low yield. As a result, routine plasma screening would yield few cases of stimulant drug in which there was neither a history nor suspicion of drug abuse in this population.

Topics: Adult; Amphetamine-Related Disorders; Cocaine; Cocaine-Related Disorders; Emergency Service, Hospital; Humans; Immunoenzyme Techniques; Mass Screening; Middle Aged; Missouri; Prospective Studies; Seizures; Single-Blind Method

A major metabolite of cocaine, benzoylecgonine, causes behavioral activation that progresses to seizures when given intraventricularly to 2-week-old rats. The seizures are characterized by running, hopping, and vocalizing and are mixed with shorter-duration tonic episodes. Pretreatment with haloperidol, at a dose aimed at blocking stereotyped behavior, did not suppress these behaviors. In contrast, seizures were prevented by antiepileptic drugs, with the order of potency being diazepam greater than phenobarbital greater than phenytoin. We hypothesize that the long-lasting cocaine metabolite, benzoylecgonine, contributes to the infant cocaine intoxication syndrome.

Topics: Animals; Animals, Suckling; Anticonvulsants; Antipsychotic Agents; Behavior, Animal; Brain; Cocaine; Female; Humans; Male; Rats; Rats, Inbred Strains; Seizures