Seizures Related to Antibiotic Use: Update

Abstract

We did a non-systematic review of articles on the Google Scholar platform from January 1992 until February 2018.Preference was given to articles in Portuguese or English whose title presented the descriptors "seizures" or "epilepsy" associated with the most commonly used classes of antibiotics: penicillins, cephalosporins, quinolones, carbapenems, metronidazole and isoniazid. From this Abstract Objective: make a review about the risk of seizures related to the use of antibiotics. Method: We perform a non-systematic review using Google Scholar platform approaching the relationship between seizures and the most used antibiotics classes in clinical practice. Results and Discussion: 34 papers in English language were used for this review. Conclusion:Rarely antibiotics may cause seizures, mainly in patients with renal dysfunction, hepatic or previous brain disease. It is important to learn about drugs at greatest risk of seizures in each class of antibiotics. The treatment involves the use of correct medications, primarilygabaergic drugs, avoiding ineffective anticonvulsants.

Antibiotic-induced epileptic seizures: mechanisms of action and clinical considerations

“…GABA receptors are categorized into GABA A (GABA A R) and GABA B receptors (GABA B R). Studies have found that GABA A R is the main type of receptor responsible for the pro-convulsive effects of βlactams, featuring both non-competitive inhibition and voltage-dependent changes [12]. The β-lactam ring structure is an important determinant of the epileptogenic properties.…”

“…Cephalosporins are competitive antagonists of the GABA A receptor. Besides GABA inhibition, another mechanism involves glutamatergic Nmethyl-D-Aspartate (NMDA) receptor agonism [12]. Among the cephalosporins, cefazolin and cefepime are most strongly associated with seizure-triggering properties.…”

“…There are numerous factors which may increase the risk of developing seizures after carbapenem administration. The most important risk factors to address before administering carbapenems are renal insufficiency, history of injury to the central nervous system (CNS) and CNS disease including pre-existing epilepsy, cerebrovascular disease such as prior stroke, trauma, and presence of CNS neoplasms [12,41,42]. Other risk factors which may lower the seizure threshold include elderly patients, liver disease, concomitant treatment with drugs carrying neurotoxic risk, current infection, and sepsis.…”

“…Exact mechanisms behind why patients treated with metronidazole are predisposed to seizure development requires further research. However, it is proposed that neurotransmitter modulation through inhibition of GABA receptors, direct drug binding to neural RNA interfering with protein synthesis, generation of neurotoxic radicals as a result of reactions with catecholamine neurotransmitters, and mitochondrial dysfunction may all play a role in enhancing the risk of seizures [12]. Neurotoxic effects of metronidazole is also illustrated by the presence of CNS lesions on neuroimaging such as cytotoxic and vasogenic edema observed at different locations within the brain.…”