Cefixime-induced nonconvulsive status epilepticus

Anzellotti, Francesca; Ricciardi, L; Monaco, Daniela; Ciccocioppo, Fausta; Borrelli, I.; Zhuzhuni, Holta; Onofrj, Marco

doi:10.1007/s10072-011-0668-3

Cited by 15 publications

(12 citation statements)

References 32 publications

(27 reference statements)

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“…Our patient was diagnosed with NCSE with continuous 2–3 Hz generalized sharp and wave. Cefepime as a causative agent was derived by similar EEG finding of cefepime induced NCSE of previous reports 4,5. And temporal relationship of consciousness change, with onset of clinical symptom in 5 days after the administration of cefepime, and improvement in 3 days after the withdrawal.…”

Section: Discussionmentioning

confidence: 63%

“…Cefepime is predominantly cleared by renal excretion and the half-life of cefepime in adults with normal renal function is approximately 2 hours 8. The neurotoxic effects of cephalosporins can range from slurred speech, tremor, confusion, aphasia, agitation, coma, myoclonus, seizure, to NCSE 5. The NCSE, in particular has been reported in patients with renal impairment and with use of third and fourth generation agents such as ceftazidime, ceftriaxone, and cefepime 9,10.…”

Section: Discussionmentioning

confidence: 99%

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Cefepime- Induced Non-Convulsive Status Epilepticus (NCSE)

Kim¹,

Kim²,

Paek³

et al. 2013

J Epilepsy Res

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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.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Cefepime- Induced Non-Convulsive Status Epilepticus (NCSE)

Kim¹,

Kim²,

Paek³

et al. 2013

J Epilepsy Res

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“… ( A , B ) Drug‐induced confusional state with epileptiform EEG changes by cefixime (Anzellotti et al., 2011). Calibration: 1 s between vertical lines; sensitivity 7 μV/mm.…”

Section: Resultsmentioning

confidence: 99%

“…Clinical/EEG description (Anzellotti et al., 2011): A 64‐year‐old woman on cefixime followed by confusion had continuous generalized spike or double‐spike and slow‐wave discharges, which were occurring at a frequency of 3–3.5 Hz and amplitudes of 100–120 μV (Fig. 39A), with sporadic inscription of polyspikes at a frequency of 14–15 Hz and amplitudes of 90–100 μV.…”

Section: Boundary Syndromesmentioning

confidence: 99%

Electroencephalographic criteria for nonconvulsive status epilepticus: Synopsis and comprehensive survey

2012

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SUMMARYThere have been many attempts at defining the electroencephalography (EEG) characteristics of nonconvulsive status epilepticus (NCSE) without a universally accepted definition. This lack of consensus arises because the EEG expression of NCSE does not exist in isolation, but reflects status epilepticus under the variety of pathologic conditions that occur with age, cerebral development, encephalopathy, and epilepsy syndrome. Current NCSE definitions include ''boundary conditions,'' in which electroencephalographic seizure activity occurs without apparent clinical seizures. Furthermore, what appears to one interpreter as status epilepticus, is not to another reader, reflecting the ''art'' of EEG interpretation. Seizures and epilepsy syndromes have undergone an evolution that has moved beyond a classification of focal or generalized conditions into a syndromic approach. It seems appropriate to make similar changes in the EEG analysis of the syndromes of NCSE. In effect, the literature on epilepsy classification has progressed to incorporate the different NCSE types with clinical descriptions, but the specific EEG evidence for these types is found largely in individual reports, and often by description only. NCSE classification of EEG patterns should derive from the aggregate of published EEG patterns in the respective clinical subtype, supported by an analysis of these EEG studies. The analysis that follows presents clinical descriptions and EEG patterns of NCSE in the neonatal period, infancy, childhood, adulthood, and late adulthood from a syndromic perspective based on age, encephalopathy, cerebral development, etiology, and syndrome. Proceeding from the proposed classification of status epilepticus syndromes in ''Status epilepticus: its clinical features and treatment in children and adults'' (published in 1994 by Cambridge University Press, New York), we have performed a systematic search for reports presenting EEG patterns of NCSE using the online medical search engine PubMed for 22 different search strategies. EEG patterns were reviewed by two board-certified epileptologists who reached consensus regarding presence of NCSE. From a total of 4,328 search results, 123 cases with corresponding EEG patterns could be allocated to underlying epilepsy syndromes. Typical characteristic, prominent electrographic patterns, and sequential arrangements are elucidated for the different NCSE syndromes. This compendium of patterns by NCSE syndrome classification with illustration of EEGs, and delineation of electroencephalographic features helps define the characteristics and semiologic borderlines among the types of NCSE. KEY WORDS: Epilepsy, Nonconvulsive status epilepticus, Electroencephalographic criteria, Diagnosis criteria, Clinical syndromes, Electroencephalographic patterns, Neonatal, Infants, Childhood, Adults, Late life.Nonconvulsive status epilepticus (NCSE) has been defined as a state of ongoing (or nonrecovery between) seizures without convulsions, usually for more than 30 min (Shorvon, 1994;Kaplan, 1996...

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“…Some antimicrobial agents (penicillins, cephalosporins, carbapenems, quinolones, and antimalarials) may precipitate seizures even in patients who do not have epilepsy. Patients with renal failure or a previous diagnosis of epilepsy are most susceptible to the toxic effects of cephalosporins [7] . Cephalosporins are epileptogenic drugs, especially when used at excessive doses or when renal function is impaired [8] .…”

Section: Discussionmentioning

confidence: 99%

Nonconvulsive status epilepticus cases arising in connection with cephalosporins

Bora

Demir

Uzun

2016

Epilepsy & Behavior Case Reports

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Cephalosporins, particularly cefepime, exert neurotoxic side effects that can lead to status epilepticus. These neurotoxic side effects include myoclonus, dystonic movements, tremor, asterixis, seizure, status epilepticus, encephalopathy, and sometimes coma. Status epilepticus, particularly nonconvulsive status epilepticus (NCSE), is a well-known but unusual complication in patients with altered renal function who were receiving treatment with intravenous cephalosporins, especially cefepime. We reviewed the clinical and electroencephalographic (EEG) characteristics of 7 patients with renal failure who developed consciousness alterations with changes in EEG activity while being treated with cephalosporins. All patients developed renal failure: six patients had chronic renal failure, one patient had acute renal failure, and two patients were administered hemodialysis. Nonconvulsive status epilepticus was observed between 2 and 8 days (average of 5.6 days) after initiation of cephalosporins. Cephalosporins are epileptogenic drugs, especially when used in excessive doses or when renal function is impaired. Critically ill patients with chronic kidney disease are particularly susceptible to cefepime neurotoxicity. Clinical and electrophysiological results of patients guide the diagnosis of NCSE by healthcare providers.

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Cefixime-induced nonconvulsive status epilepticus

Cited by 15 publications

References 32 publications

Cefepime- Induced Non-Convulsive Status Epilepticus (NCSE)

Cefepime- Induced Non-Convulsive Status Epilepticus (NCSE)

Electroencephalographic criteria for nonconvulsive status epilepticus: Synopsis and comprehensive survey

Nonconvulsive status epilepticus cases arising in connection with cephalosporins

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