Nonconvulsive status epilepticus secondary to paclitaxel administration

Abstract

Nonconvulsive status epilepticus (NCSE) can be triggered by metabolic disturbances and drugs in adults without previous epilepsy. We present the case of a 51-year-old woman without previous history of epilepsy and recently diagnosed with infiltrating lobular breast carcinoma. Following the administration of paclitaxel–cremophor, she presented a striking disinhibited behavior with episodic spatial disorientation, emotional indifference, and irritability. Urgent EEG was consistent with NCSE. Clinical improvement and resolution of EEG abnormalities were observed following the administration of intravenous levetiracetam and lacosamide. Other causes of NCSE were ruled out, and antiepileptic drugs were slowly tapered off without new episodes of abnormal behavior after three months of follow-up. We have reported the first case of NCSE secondary to paclitaxel–cremophor. Neurologists and oncologists should consider NCSE as an unusual complication of treatment with paclitaxel–cremophor in patients without a history of epilepsy.

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

“…Although LCM is not FDA approved for SE, it has been evaluated in this setting in multiple case series, case reports, and retrospective reviews . The populations studied varied in the types of SE encountered: generalized, convulsive, absence, focal, complex partial, nonconvulsive, refractory, and super refractory (Table ).…”

“…Earlier evidence regarding the use of LCM in SE was available as case reports, most of which were published shortly after LCM entered the market (Table ) …”

“…Earlier evidence regarding the use of LCM in SE was available as case reports, most of which were published shortly after LCM entered the market ( Table 5). [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Several studies evaluated the dosing of LCM in SE. One prospective investigation 59 compared a 400-mg IV dose with a 200-mg dose after experiencing poor responses with the latter regimen in 25 patients with SE or RSE.…”

Lacosamide in status epilepticus: Systematic review of current evidence

“…Illan‐Gara et al describe a 51‐year‐old patient with breast cancer who developed NCSE as first manifestation of epilepsy following the administration of paclitaxel‐cremophor for chemotherapy. LCM 200 mg i.v., led to clinical seizure termination after intravenous levetiracetam had already markedly improved EEG . Fernández‐Torre et al reported a patient with NCSE following multiple cerebral fat emboli during orthopaedic surgery.…”

“…LCM 200 mg i.v., led to clinical seizure termination after intravenous levetiracetam had already markedly improved EEG. 62 Fern andez-Torre et al reported a patient with NCSE following multiple cerebral fat emboli during orthopaedic surgery. After extensive pretreatment with intravenous midazolam, intravenous levetiracetam and transient sedation with intravenous propofol and midazolam, the patient was given valproate and lacosamide.…”