Nguyen Clever, Clegg Taylor, Kumar Ashutosh, Paudel Sita
Penn State College of Medicine, Hershey, PA, USA.
Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
Child Neurol Open. 2022 Aug 7;9:2329048X221119575. doi: 10.1177/2329048X221119575. eCollection 2022 Jan-Dec.
Cefepime, a fourth-generation cephalosporin, is known to risk the induction of neurotoxic impairment from confusion to nonconvulsive status epilepticus (NCSE). Neurotoxic effects of cefepime are most commonly evident in the setting of impaired renal function in adults; however, are rarely present in those with normal renal excretion function or in the pediatric population. We present a case of a 16-year-old female with a complicated past medical history but no accounts of impaired renal function yet, after starting cefepime, presented with encephalopathy, intermittent stimulus-induced posturing, and was found to have NCSE. Discontinuation of cefepime and administration of additional antiepileptics provided significant improvement in EEG and allowed the patient to return to baseline within two days. Cefepime-induced nonconvulsive status epilepticus should be considered in any patient with or without impaired renal function that shows acute changes in mental status, and/or reduced consciousness, after initiating cefepime treatment.
头孢吡肟是一种第四代头孢菌素，已知有引发从意识模糊到非惊厥性癫痫持续状态（NCSE）的神经毒性损害的风险。头孢吡肟的神经毒性作用在成人肾功能受损的情况下最为常见；然而，在肾功能排泄功能正常的人群或儿科人群中很少出现。我们报告一例16岁女性病例，该患者既往病史复杂，但尚无肾功能受损记录，在开始使用头孢吡肟后，出现脑病、间歇性刺激诱发的姿势异常，并被发现患有NCSE。停用头孢吡肟并给予额外的抗癫痫药物后，脑电图有显著改善，患者在两天内恢复到基线状态。在开始头孢吡肟治疗后，任何出现精神状态急性变化和/或意识减退的患者，无论肾功能是否受损，都应考虑头孢吡肟诱发的非惊厥性癫痫持续状态。
