Stimulus-induced Rhythmic, Periodic, or Ictal Discharges (SIRPDs) associated with seizures in cefepime neurotoxicity

Passarelli, Valmir; Conceição, Maria Paula Oliveira Moutinho da; Trés, Eduardo Sturzeneker; Alves-Junior, José Furtado; Baldocchi, Meire Argentoni

doi:10.1590/0004-282x20140094

Cited by 13 publications

(5 citation statements)

References 4 publications

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“…[1][2][3] Identified causes of SIRPIDs include primary cerebral symptoms, such as intracranial hemorrhages, 1 neurodegenerative diseases, 4 and traumatic brain injury, 3 and systemic symptoms, such as anoxic brain injury, [1][2][3]5 metabolic disturbances, 1 and drug toxicity. 6 The pathophysiologic mechanisms and ultimate clinical implications of SIRPIDs remain uncertain. Some data suggest that they do not represent an ictal pattern as evidenced by negative single-photon emission computed tomography results 7,8 ; however, clinical improvement and resolution of SIRPIDs have been reported after treatment with benzodiazepines.…”

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confidence: 99%

Associated Factors and Prognostic Implications of Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges

et al. 2016

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The implications of stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) sometimes found on prolonged electroencephalographic (EEG) recordings are uncertain. OBJECTIVE To evaluate the incidence of SIRPIDs and their clinical implications in critically ill patients. DESIGN, SETTING, AND PARTICIPANTS A multicenter, international retrospective study was performed from October 1, 2012, through September 30, 2014, of consecutive adult patients hospitalized in intensive care units with alteration of consciousness who underwent EEG recordings at 3 separate centers. Demographic data, including admission diagnosis, age, sex, history of epilepsy, and EEG findings, were noted. Characteristics of SIRPIDs were documented. Data were evaluated for predictors of SIRPIDs and in-hospital mortality. Data analysis was performed from January 16, 2015, to June 15, 2015. MAIN OUTCOMES AND MEASURES Incidence of SIRPIDs, association of SIRPIDs with mortality and other EEG characteristics, and EEG and clinical predictors of mortality. RESULTS A total of 416 patients were studied. The median age of patients was 60 years (interquartile range, 46-71 years), and 252 (60.6%) were male. A total of 104 patients (25.0%) did not survive to hospital discharge. SIRPIDs were identified in 43 patients (10.3%). The proportion of patients with SIRPIDs was not significantly different across the 3 sites (P = .34). Anoxic brain injury (odds ratio [OR], 3.80; 95% CI, 1.73-8.33; P < .001), the use of antiepileptic medications (OR, 3.24; 95% CI, 1.31-8.00; P = .01), electrographic seizures (OR, 2.85; 95% CI, 1.13-7.19; P = .03), generalized periodic discharges with triphasic morphologic features (OR, 3.66; 95% CI, 1.67-8.02; P = .001), and sporadic sharp waves and periodic discharges (OR, 2.59; 95% CI, 1.13-5.92; P = .02) were independently associated with the presence of SIRPIDs. Older age (OR, 1.02; 95% CI, 1.01-1.04; P = .005), anoxic brain injury (OR, 3.49; 95% CI, 1.96-6.21; P Յ .001), and absence of EEG reactivity (OR, 8.14; 95% CI, 4.20-15.79; P < .001) but not SIRPIDs (OR, 1.73; 95% CI, 0.79-3.78; P = .17) were independently associated with in-hospital mortality. CONCLUSIONS AND RELEVANCE In critically ill patients undergoing EEG recordings, SIRPIDs occurred in 43 (10.3%) and were associated with other electrographic abnormalities previously reported to indicate poor prognosis. However, SIRPIDs were not independently associated with in-hospital mortality.

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confidence: 99%

Associated Factors and Prognostic Implications of Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges

et al. 2016

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“…8 Reported associated EEG patterns include rhythmic triphasic waves which are nonreactive to stimulation, 1 –3 nonconvulsive status epilepticus with generalized spike and slow-wave or sharp and slow-wave activity, 1,6,8,9 and generalized periodic discharges. 10 One case of stimulus-responsive EEG changes has been reported previously 11 in a patient with renal failure and no intracranial pathology. Each of these features in isolation could warrant treatment with antiepileptic medications; therefore, investigating the potential causes of electroclinical abnormalities rather than solely treating with additional drugs is of vital importance.…”

Section: Discussionmentioning

confidence: 99%

Cefepime-Associated SIRPIDs in a Patient With Normal Renal Function

Johnson

Hannawi

Martinez

et al. 2016

The Neurohospitalist

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Cefepime has been associated with encephalopathy and with nonconvulsive seizure activity, primarily in patients with renal impairment. Here, we report a case of cefepime-associated encephalopathy in a patient with normal renal function with stimulus-induced rhythmic activity seen on electroencephalogram, which resolved on discontinuation of cefepime. We bring this to the attention of the neurohospitalist community, as cefepime is widely used in the hospital setting, and cefepime-related neurotoxicity may go overlooked, especially in patients with normal renal function. Neurologists must recognize drug-related patterns, as the treatment is removing a medication rather than adding an antiepileptic medication.

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“…EEG is also a precious tool to investigate CNS ADRs, 3 4 of the EEG in this study were abnormal when recorded, with signs of encephalopathy. Previous studies highlighted these specific signs with cephalosporin-induced encephalopathy, such as triphasic waves or slow-wave discharges [49,50]. Plasma concentrations and EEG provide essential cues regarding the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Serious Neurological Adverse Events of Ceftriaxone

et al. 2021

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We described ceftriaxone-induced CNS adverse events through the largest case series of Adverse Drug Reactions (ADRs) reports, from 1995 to 2017, using the French Pharmacovigilance Database. In total, 152 cases of serious CNS ADRs were analyzed; 112 patients were hospitalized or had a prolonged hospitalization (73.7%), 12 dead (7.9%) and 16 exhibited life-threatening ADRs (10.5%). The median age was 74.5 years, mainly women (55.3%), with a median creatinine clearance of 35 mL/min. Patients mainly exhibited convulsions, status epilepticus, myoclonia (n = 75, 49.3%), encephalopathy (n = 45, 29.6%), confused state (n = 34, 22.4%) and hallucinations (n = 16, 10.5%). The median time of onset was 4 days, and the median duration was 4.5 days. The mean daily dose was 1.7 g mainly through an intravenous route (n = 106, 69.7%), and three patients received doses above maximal dose of Summary of Product Characteristics. Ceftriaxone plasma concentrations were recorded for 19 patients (12.5%), and 8 were above the toxicity threshold. Electroencephalograms (EEG) performed for 32.9% of the patients (n = 50) were abnormal for 74% (n = 37). We described the world’s biggest case series of ceftriaxone-induced serious CNS ADRs. Explorations (plasma concentrations, EEG) are contributive to confirm the ceftriaxone toxicity-induced. Clinicians may be cautious with the use of ceftriaxone, especially in the older age or renal impairment population.

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Stimulus-induced Rhythmic, Periodic, or Ictal Discharges (SIRPDs) associated with seizures in cefepime neurotoxicity

Abstract: Descargas ictais, periódicas ou rítmicas induzidas por estímulos (SIRPIDs) associadas a crises epilépticas na neurotoxicidade por cefepime Figure). Cefepime was discontinued. Subsequent EEG demonstrated only slowed background (SB).

Cited by 13 publications

References 4 publications

Associated Factors and Prognostic Implications of Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges

Associated Factors and Prognostic Implications of Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges

Cefepime-Associated SIRPIDs in a Patient With Normal Renal Function

Serious Neurological Adverse Events of Ceftriaxone

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