Cefepime- Induced Non-Convulsive Status Epilepticus (NCSE)

Abstract

Cefepime is a fourth-generation B-lactam cephalosporin, commonly used in immunosuppressed patients. Neurotoxicity, which present as nonconvulsive status epilepticus (NCSE), has been reported previously especially in adult patients with impaired renal function. We present a case of cefepime induced NCSE after recovering from acute renal failure. A 71-year-old woman was hospitalized for right lower lobe lobectomy after diagnosis of lung cancer. Although she had successful lobectomy, she underwent several post operative complication including operation site bleeding, acute renal failure, acute respiratory distress syndrome, and atypical pneumonia. Her renal failure was prerenal type after massive operation site bleeding, and continuous renal replacement therapy (CRRT) were started for renal replacement treatment. After 5 days of renal replacement therapy, her serum creatinine level was much improved from 2.7 mg/dL to 1.33 mg/dL. Cefepime renal dose were started, when atypical pneumonia became resistant to imipenem and vancomycin. After 5th day of cefepime use, the patient became stupor and developed one episode of brief generalized myoclonic seizure. Her electroencephalograph (EEG) revealed 2–3 Hz generalized sharp and with impression of NCSE, she was started on anti-epileptic treatment. Clinical symptoms improved 3 days after discontinuation of cefepime. She was than diagnosed with cefepime induced non convulsive status epilepticus. Anti-epileptic treatments were than discontinued uneventfully. Awareness of the potential neurotoxic clinical manifestations of various antibiotics and high degree of vigilance in critically ill patients is essential in identifying a potentially serious though reversible complication of antibiotic therapy.

Cefepime-induced neurotoxicity: a systematic review

“…1 ). With the exception of a prospective cohort trial [ 13 ], all studies were retrospective, including 19 single-case reports [ 1 , 14 – 31 ], 9 case series [ 2 , 11 , 32 – 38 ], and 8 retrospective cohort studies [ 4 , 5 , 39 – 44 ]. As shown in Table 1 , patients were predominantly elderly (median 69 years), had renal dysfunction (80%), and required intensive care (81%).…”

Cefepime-Induced Encephalopathy and Nonconvulsive Status Epilepticus: Dispelling an Artificial Dichotomy

“…Based on this dichotomized labeling, those deemed to have "NCSE" were more likely to receive one or more anti-seizure medication (ASM), while others labeled "encephalopathic" often just had their cefepime discontinued without additional interventions. 4,[7][8][9]11,12 Indeed, on review of prior cases outlined in Table 1, 100% of those labeled NCSE received an ASM compared to only 15% of those who were labeled as having an encephalopathy. No report prior to our case series clearly demonstrated a positive electroclinical response to ASMs (as in our case, the clinical improvements were only partial), while all earlier publications on this topic, regardless of whether they labeled the case as encephalopathy or NCSE, report resolution of the altered mentation after cefepime discontinuation.…”

Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

“…Many cases resolved spontaneously upon withdrawal of the medication, but fatal evolutions are also reported. Besides stopping cefepime, treatment generally has consisted of supportive measures and, occasionally, the administration of antiepileptic drugs (Table ) . A few cases have been treated with iHD (Table ) with a globally favorable outcome .…”