Although cocaine has been found to be a cardiotoxin, the pathogenesis of this toxicity is not well dened (Cregler and Mark 1987). Cocaine use has also been linked to the occurrence of subarachnoid hemorrhage, hypertension, ventricular arrhythmia, tachycardia, acute myocardial infarction, seizure, and sudden death (Lichtenfeld et al. 1984; Nahas et al. 1985; Tazelaar et al. 1987; Young and Glauber 1947). Persons with epilepsy have been shown to manifest autonomic dysfunctions similar to those manifested by cocaine users,

11.1 Introduction 169 11.2 Mechanisms of Action of Cocaine 170 11.3 Cocaine-Induced Sudden Death 172

11.3.1 Cocaine-Induced Changes in Mean Arterial Blood Pressure and Heart Rate 172

11.3.2 Cocaine-Induced Myocardial Ischemia, Infarction, Arrhythmia, and Cardiomyopathies 174

11.3.3 Cocaine-Induced Changes in Postganglionic Cardiac Sympathetic Neural Function 176

11.3.4 Central Actions of Cocaine 176 11.3.5 Cocaine-Induced Seizures 179

11.4 Treatment of Cocaine-Induced Arrhythmias and Seizures 180 11.5 Use of Cocaine in Persons with Epilepsy 181 11.6 Summary 181 References 182

including changes in blood pressure and heart rate and rhythm, phenomena that may be contributory to sudden unexpected death (Leestma et al. 1984; Peneld and Erickson 1941; Phizackerly et al. 1954; Walsh et al. 1968). us, one must ask whether the use of cocaine in individuals with epilepsy places these individuals at risk of dying in a sudden unexplained manner.