Cocaine-associated dystonic reaction

Dystonic reactions are extrapyramidal motor dysfunctions that result from an insufficient activity of nigrostriatal dopamine and present clinically as spasms of the various muscle groups. Neuroleptic drugs are a known cause of dystonia and are the most frequently encountered trigger. Cocaine use has been associated with dystonias, though much less often. When reported in the setting of a dystonic reaction, cocaine has been described as a predisposing factor for the patient already using 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 are presented, with a discussion of the pathophysiology and treatment alternatives.