Meyer Michael A
Department of Neurology, Sisters Hospital , Buffalo, NY, USA.
Neurol Int. 2014 Jun 16;6(2):5349. doi: 10.4081/ni.2014.5349. eCollection 2014 Apr 22.
A 66-year-old male receiving intravenous piperacillin and nafcillin for a post-surgical wound infection developed intermittent myoclonic jerks of all four extremities that disappeared after discontinuation of these two medications. In addition there was a mild yet definite intermittent encephalopathic effect; head computed tomography examination as negative and there was no prior history for seizure or myoclonus. These two beta lactam ring antibiotics are structurally similar to penicillin, which is well known to induce not only myoclonus but also seizure activity by reducing the gamma-aminobutyric acid (GABA) induced inhibitory currents by inducing an open chloride channel block of the GABA type A receptors within the brain. Clinicians need to be fully aware of the potential epileptogenic effects of piperacillin, nafcillin, and related antibiotics.
一名66岁男性因术后伤口感染接受静脉注射哌拉西林和萘夫西林治疗，出现四肢间歇性肌阵挛性抽搐，停用这两种药物后抽搐消失。此外，还存在轻度但明确的间歇性脑病效应；头部计算机断层扫描检查结果为阴性，且既往无癫痫或肌阵挛病史。这两种β-内酰胺环抗生素在结构上与青霉素相似，众所周知，青霉素不仅可通过诱导大脑内A型γ-氨基丁酸（GABA）受体的氯离子通道开放阻滞来降低GABA诱导的抑制性电流，从而诱发肌阵挛，还可诱发癫痫活动。临床医生需要充分认识到哌拉西林、萘夫西林及相关抗生素的潜在致癫痫作用。
