Nonconvulsive Status Epilepticus Related to Posterior Reversible Leukoencephalopathy Syndrome Induced by Cetuximab

Palma, Jose‐Alberto; Gómez‐Ibáñez, Asier; Martín, Beatriz; Urrestarazu, Elena; Gil-Bazo, Ignacio; Pastor, María A.

doi:10.1097/nrl.0b013e3182173655

Cited by 20 publications

(9 citation statements)

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“…7 These findings were present in our patient (Figures 2-5). Other leukoencephalopathies such as posterior reversible encephalopathy syndrome may occur in patients who underwent transplant and also be associated with NCSE, 8 though the lesion locations on MRI and clinical course help distinguish these conditions. The mechanism of ME is unknown, yet the features on brain MRI may be reversible potentially reflecting the presence of interstitial edema.…”

Section: Discussionmentioning

confidence: 99%

Nonconvulsive Status With Metronidazole

Cantador

Meschia

Freeman

et al. 2013

The Neurohospitalist

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Objective: To expand the adverse events associated with metronidazole to include nonconvulsive status epilepticus (NCSE). Design: Observational single case report of a rare association. Setting: Hospitalized lung transplant recipient treated with metronidazole for prevention of infection. Patient: A 56-year-old man with systemic symptoms, peripheral neuropathy, generalized seizure, and a subsequent acute deterioration of mental status due to NCSE. Interventions: Administration of midazolam was successful in terminating status epilepticus. Main Outcome Measures: Abrupt termination of NCSE was evident on continuous bedside electroencephalogam associated with clinical resolution of mental status. Results: Recovery occurred from NCSE eventually deteriorating to a fatal outcome. Conclusions: Metronidazole may be associated with successfully treated NCSE.

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Section: Discussionmentioning

confidence: 99%

Nonconvulsive Status With Metronidazole

Cantador

Meschia

Freeman

et al. 2013

The Neurohospitalist

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“…Reversible posterior leukoencephalopathy syndrome, of which clinical symptoms include headache, decreased alertness, and mental abnormalities, is a disorder with typical radiologic findings in the posterior regions of the cerebral hemisphere and cerebellum. [9] Neutropenia is the most common dose-limiting toxicity of myelosuppressive chemotherapy and has been found in 51% of patients who were treated for lymphoma or solid tissue malignancy. [10] Neutropenia also puts patients at high risk of infection, which can be life-threatening.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk of Severe Neutropenia in Advanced Cancer Patients Treated with Cetuximab

et al. 2011

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Background and Aim: Neutropenia is a serious adverse event for patients who are treated with cetuximab, an inhibitor of endothelial growth factor receptor. However, there is no consistent result of the relationship between cetuximab and neutropenia in randomized controlled trials (RCTs). We did a systematic review and meta-analysis of published RCTs to assess the overall risk of neutropenia associated with cetuximab.Methods: PubMed, Cochrane Central Register of Controlled Trials, EMBASE, and American Society of Clinical Oncology conferences were searched for relevant RCTs. Quantitative and qualitative analyses were carried out to evaluate the association between neutropenia and cetuximab. Both the fixed-effect model and random-effects model were used.Results: A total of 7186 patients with a variety of advanced cancers from 14 trials were included in our analysis. The overall incidence of neutropenia in patients receiving cetuximab was 33% (95% CI 26, 43). Patients treated with cetuximab had a significantly increased risk of neutropenia compared with patients treated with control medication, with a relative risk (RR) of 1.12 (95% CI 1.05, 1.19; fixed-effect model). Risk varied with tumor type. Higher risks were observed in patients with colorectal carcinoma (RR 1.17; 95% CI 1.04, 1.32; fixed-effect model) and non-small cell lung cancer (RR 1.07; 95% CI 0.99, 1.16; fixed-effect model).Conclusion: Cetuximab is associated with a significant risk of neutropenia in patients with advanced cancer receiving concurrent chemotherapy.

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“…However, a recent report described the first published case of a patient developing posterior reversible leukoencephalopathy syndrome with concomitant hypertension (150/110 mm Hg) after cetuximab administration. 12 The patient experienced generalized tonic-clonic seizures approximately six hours after the infusion followed by nonconvulsive status epilepticus that required two days of treatment with propofol and mechanical ventilation. Our patient did not develop hypertension and was found to be hypotensive by the emergency resuscitation team.…”

Section: Discussionmentioning

confidence: 99%