Royal Perth Hospital, Department of Neurology, Perth, Western Australia, Australia.
Royal Perth Hospital, Department of Neurology, Perth, Western Australia, Australia; Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia.
J Clin Neurosci. 2019 Sep;67:163-166. doi: 10.1016/j.jocn.2019.05.035. Epub 2019 Jun 11.
Metabolic encephalopathy and Non-Convulsive Status Epilepticus (NCSE) have been reported with cephalosporin use, particularly cefepime. We aimed to analyze the clinical and EEG findings in patients with cephalosporin-related neurotoxicity (CRN) at our hospital identified via the hospital EEG database, and to critically review CRN case reports in the literature. A Medline search was performed to identify CRN cases where a representative sample of EEG was provided. EEGs were analyzed using published criteria differentiating NCSE from triphasic waves (TW). Eleven patients at our hospital were identified with CRN (9 cefepime, 2 ceftriaxone): all had an encephalopathy with decreased consciousness and/or confusion. One patient had clinical seizures and 6 had multifocal myoclonus. All patients had abnormal EEGs, all with moderate to severe generalized slowing and 10 also with TW. Recovery was related to cephalosporin withdrawal rather than antiepileptic therapy. Analysis of 37 EEG samples of CRN patients reported in the literature as NCSE (30) or TW (7) revealed that most did not meet criteria for NCSE, with 33 showing TW, 1 showing generalised epileptiform discharges and 3 being uninterpretable. CRN usually produces a toxic encephalopathy rather than NCSE, and is commonly associated with triphasic waves on EEG. In most patients anti-epileptic and/or sedative drugs do not hasten clinical improvement.
已报道头孢菌素类药物（尤其是头孢吡肟）使用相关的代谢性脑病和非惊厥性癫痫持续状态（NCSE）。我们旨在通过医院脑电图数据库分析我院头孢菌素相关神经毒性（CRN）患者的临床和脑电图表现，并对文献中 CRN 病例报告进行批判性回顾。进行了 Medline 检索，以确定提供代表性脑电图样本的 CRN 病例。使用已发表的标准分析脑电图，以区分 NCSE 与三相波（TW）。我院共发现 11 例 CRN 患者（9 例使用头孢吡肟，2 例使用头孢曲松）：均有不同程度意识障碍和/或意识模糊的脑病。1 例患者出现临床癫痫发作，6 例患者出现多灶性肌阵挛。所有患者的脑电图异常，均有中重度全面性减慢，10 例患者还有 TW。恢复与头孢菌素类药物停用相关，而非抗癫痫治疗。对文献中报告的 37 例作为 NCSE（30 例）或 TW（7 例）的 CRN 患者的脑电图样本进行分析，发现大多数不符合 NCSE 标准，其中 33 例表现为三相波，1 例表现为全面性癫痫样放电，3 例不可解释。CRN 通常引起中毒性脑病而非 NCSE，通常与脑电图上的三相波相关。在大多数患者中，抗癫痫和/或镇静药物不会加速临床改善。
