Kilickap Saadettin, Cakar Mustafa, Onal Ibrahim K, Tufan Abdurrahman, Akoglu Hadim, Aksoy Sercan, Erman Mustafa, Tekuzman Gulten
Department of Medical Oncology, Hacettepe University Institute of Oncology, Sihhiye, Ankara, Turkey.
Ann Pharmacother. 2006 Feb;40(2):332-5. doi: 10.1345/aph.1G363. Epub 2006 Jan 31.
To report 2 cases of nonconvulsive status epilepticus (NCSE) following infusion of ifosfamide.
Two patients who received ifosfamide-containing chemotherapy developed NCSE. One woman received ifosfamide 1000 mg/m2 (1 h infusion on days 1-5); confusion, lethargy, and speech deterioration developed on day 3. The second patient developed similar symptoms on day 3 of treatment with 2500 mg/m2. Both patients responded to intravenous administration of diazepam 10 mg and were given levetiracetam as maintenance therapy.
The severity and presentation of central nervous system toxicity due to ifosfamide varies greatly and involves a spectrum ranging from subclinical electroencephalogram changes to coma. NCSE, an epileptic disorder in which typical convulsive activity is absent, has previously been reported in only 4 patients receiving ifosfamide. Levetiracetam may be used for maintenance antiepileptic therapy after diazepam administration.
Among the many presentations of ifosfamide neurotoxicity, clinicians should consider NCSE as a possible explanation for changes in consciousness in a patient receiving this agent. An objective causality assessment by use of the Naranjo probability scale revealed that NCSE due to ifosfamide was probable.
报告2例异环磷酰胺输注后发生的非惊厥性癫痫持续状态（NCSE）。
两名接受含异环磷酰胺化疗的患者发生了NCSE。一名女性接受异环磷酰胺1000mg/m²（第1 - 5天静脉输注1小时）；第3天出现意识模糊、嗜睡和言语功能减退。第二名患者在接受2500mg/m²治疗的第3天出现了类似症状。两名患者静脉注射10mg地西泮后均有反应，并给予左乙拉西坦作为维持治疗。
异环磷酰胺所致中枢神经系统毒性的严重程度和表现差异很大，范围从亚临床脑电图改变到昏迷。NCSE是一种无典型惊厥活动的癫痫疾病，此前仅有4例接受异环磷酰胺治疗的患者有过相关报道。左乙拉西坦可在给予地西泮后用于维持抗癫痫治疗。
在异环磷酰胺神经毒性的多种表现中，临床医生应考虑NCSE是接受该药物治疗患者意识改变的一种可能原因。使用Naranjo概率量表进行的客观因果关系评估显示，异环磷酰胺所致NCSE很可能发生。
