Shebani Zacharia, Walter Brian, Masel Todd, Patel Chilvana, Li Xiangping
Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.
Neurology, Houston Methodist Hospital, Houston, USA.
Cureus. 2023 Apr 24;15(4):e38050. doi: 10.7759/cureus.38050. eCollection 2023 Apr.
Neurotoxicity is a well-known side effect of cefepime among patients commonly present with altered mental status and typical electroencephalogram (EEG) findings of generalized periodic discharges (GPDs). Some practitioners consider this pattern as encephalopathy and often treat it with the withdrawal of cefepime only, while others are at times concerned with non-convulsive status epilepticus (NCSE) and treat it with antiseizure medications (ASMs) in addition to the withdrawal of cefepime to accelerate the recovery. We present a case series of two patients who developed cefepime-induced altered mental status and EEG findings of GPDs at a rate of 2-2.5 Hz concerning for the ictal-interictal continuum (IIC). Both cases were treated as possible NCSE with ASMs in addition to the withdrawal of cefepime, resulting in different clinical outcomes. The first case showed clinical and EEG improvement shortly after the administration of parenteral benzodiazepines and ASMs. The other case showed electrographic improvement but did not show significant improvement in mentation, and the patient died eventually.
神经毒性是头孢吡肟常见的副作用，在患者中通常表现为精神状态改变以及脑电图（EEG）出现典型的广泛性周期性放电（GPDs）。一些医生将这种模式视为脑病，通常仅通过停用头孢吡肟来治疗，而另一些医生有时会担心非惊厥性癫痫持续状态（NCSE），除了停用头孢吡肟外，还会使用抗癫痫药物（ASMs）进行治疗，以加速恢复。我们报告了一个包含两名患者的病例系列，这两名患者出现了头孢吡肟诱导的精神状态改变以及频率为2 - 2.5赫兹的GPDs脑电图表现，这与发作期 - 发作间期连续体（IIC）相关。两例均在停用头孢吡肟的基础上，作为可能的NCSE使用ASMs进行治疗，结果出现了不同的临床结局。第一例在给予静脉注射苯二氮䓬类药物和ASMs后不久，临床症状和脑电图均有改善。另一例脑电图有所改善，但精神状态未显著改善，患者最终死亡。
